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Indiana Reconsiders CON Repeal as South Carolina Contemplates Changes

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Republican leaders in Indiana look to reinstitute the state’s Certificate of Need program

In 1999 the state of Indiana repealed its Certificate of Need (CON) program, a complex regulatory framework aimed to ensure access to health services and control healthcare growth. Among the reasons to repeal CON was the idea that unstifled competition in healthcare would lead to lower costs and increased innovation. 

According to a recent report from the Indianapolis Star, Republican Senator John Ruckelshaus is leading the charge to reinstall CON after what he sees as unnecessary and duplicative healthcare growth in his affluent district just north of Indianapolis. Supporters in Ruckelshaus’ district believe that CON would help prevent the rapid growth of services that are driving up healthcare costs in the area. 

The legislation introduced in Indiana would create a process whereby healthcare providers must prove a community need before winning state approval to build a new hospital. “It’s been open season, if you will, for hospitals to be able to build in Indiana,” said Senator Ruckelshaus. “There are more hospitals along North Meridian than there are car dealerships along Keystone Avenue.”

Thirty-five states continue to maintain some form of CON program while 12 states have discontinued their programs altogether. Three states (Wisconsin, Minnesota and Arizona) have adopted a variation of CON to manage the growth of healthcare services. 

Meanwhile, a bill has been introduced in South Carolina to fully repeal the state’s CON program. And several other surrounding states – including Georgia, North Carolina, Florida, Tennessee and Virginia – are currently considering legislation that would repeal or significantly reduce the scope of their CON laws. 

SCHA recognizes that much has changed in the state’s healthcare landscape and therefore supports modernizing and streamlining the process to improve and protect access to care. Full repeal of the state’s CON program could have unintended consequences for rural and border hospitals and create an unlevel playing field with neighboring states. 

We also recognize that the state’s healthcare community is not unified in its position on CON, and we continue to engage and survey our members to better understand the impact the program has on hospitals and health systems in South Carolina.