The Petersburg Chamber of Commerce, the York County Chamber of Commerce, and the City of Virginia Beach are the latest entities to formalize their support for reforming Virginia’s effective Certificate of Public Need (COPN) program to enhance the process that helps promote health care access, control costs, and support charity care in the Commonwealth.
They join a growing list of Chambers of Commerce, business leaders, health care advocates, and other stakeholders urging the Virginia General Assembly to enhance and protect COPN by reforming it in a manner consistent with recommendations recently made by a state work group. The groundswell of voices continues to grow as the legislature considers proposals to alter the longstanding COPN process that helps promote quality health care for patients and offset unfunded charity care mandates on hospitals.
Local hospitals and health systems throughout the Commonwealth support appropriate reforms that enhance the program and establish guidelines for future refinement. There is widespread opposition to wholesale COPN repeal among Virginia’s local hospitals and health systems because of the serious threat that would pose to our health care system.
Support for thoughtful COPN reform exists among many business and community organizations, including the:
- Bristol Chamber of Commerce
- Greater Williamsburg Chamber & Tourism Alliance
- Hampton Roads Chamber of Commerce
- Petersburg Chamber of Commerce
- Prince William Chamber of Commerce
- Roanoke Regional Chamber of Commerce
- Virginia Peninsula Chamber of Commerce
- York County Chamber of Commerce
- City of Virginia Beach
- Virginia Hospital & Healthcare Association
- Virginia Rural Health Association
- Virginia Nurses Association
The position taken by the chambers and other entities is in line with the recommendations of a state work group created last year at the direction of the General Assembly. After spending much of 2015 thoroughly studying how COPN works, the work group concluded that the program should be modernized but remain in place.
“The Prince William Chamber supports the recommendations of the COPN work group,” said Brendon Shaw, Director of Government Relations for the Prince William Chamber of Commerce. “We agree that while certain modernization efforts are necessary, a full repeal of Virginia’s COPN laws creates serious concerns and uncertainty for some of our region’s largest employers – our local hospitals. Unfortunately, health care is not a free market. Before completely eliminating COPN regulations that have been in place for nearly 50 years, the Commonwealth should take time to carefully evaluate the impact full repeal will have on both the industry and access to care.”
Bi-partisan legislation sponsored by Delegate Chris Stolle (R-Virginia Beach) and Senator William Stanley Jr. (R-Franklin County) embodies the recommendations of the work group. Their proposals provide a mechanism for meaningful reforms to the COPN program now and in the future. Delegate Stolle’s HB 1083 has many co-patrons from both sides of the aisle and both chambers of the General Assembly, including roughly one-fourth of all House of Delegates’ members. Senator Stanley’s SB 641 likewise has gained bi-partisan support in the House of Delegates and the Virginia Senate.
Virginia’s COPN program protects health care access, controls patient costs, and offsets unfunded charity care mandates on hospitals. The majority of states (36) maintain COPN-like programs because they are effective at preventing over-expansion the health care market can’t sustain. Virginia is home to 107 local hospitals and 30 health systems which serve as economic pillars.
Together, they provide 115,000 good-paying jobs totaling roughly $8 billion in payroll, making hospitals among the largest employers in the state. Hospitals generate $36 billion in positive economic activity for the Commonwealth, and support local economies by spending $17 billion on goods and services with local businesses. Those benefits are threatened by unfunded government mandates and federal funding cuts to hospitals which are forecast to approach $1 billion annually by 2021. Those benefits also are at risk as a result of billions of dollars in uncompensated care hospitals have absorbed in recent years. Virginia hospitals provided $3.8 billion in charity care from 2008-2014.
Meanwhile, Medicaid reimbursement rates declined from 79 percent to 66 percent from 2000-2016. And since the turn of the century, Virginia has averaged more than 920,000 uninsured citizens, many of whom turn to hospitals for charity care. The positive benefits from health care would be further imperiled by a repeal of COPN, which could weaken health care across Virginia. Going that route would allow new entrants to cherry pick only the most profitable types of care to provide, in select communities, leaving community hospitals with the burden to provide other services a community needs even though providing those services often represents a financial loss for hospitals.
Without COPN, health care access disparities could widen in Virginia, leaving poorer communities with fewer treatment options in comparison to more affluent areas.
Health care is not a free market. Federal law requires hospitals to provide emergency care regardless of a patient’s ability to pay. Also, many patients who need hospital care are uninsured, underinsured, or are covered by federal or state health programs that do not cover hospitals’ full costs for delivering care. Beyond mandates, Virginia hospitals deliver charitable care because it is central to their community-based service missions. Virginia’s local hospitals, many of which are nonprofits, are committed to caring for those who need medical attention no matter the day or time. That dedication is one reason hospitals are economic pillars and community cornerstones in the Commonwealth. COPN functions to offset charity care. More than $1.3 billion was provided toward Virginia charity care needs in 2013 due to COPN conditions. And despite the fact that health care is not a free market, Virginia has comparatively low health care costs. In fact, Virginia has lower per capita health care costs, and expenses, than the majority of non-COPN states.
In light of the circumstances, several chambers of commerce across the Commonwealth support efforts to protect Virginia’s COPN process. The Bristol Chamber of Commerce, the Greater Williamsburg Chamber & Tourism Alliance, the Petersburg Chamber of Commerce, the Prince William Chamber of Commerce, the Virginia Peninsula Chamber of Commerce, and the York County Chamber of Commerce have each endorsed resolutions that support “Virginia’s COPN program as an important component of the Commonwealth’s health care policy,” encourage the 2016 Virginia “General Assembly to enact COPN process reforms” consistent with the state work group recommendations, and request that the legislature establish a process for continued COPN review to ensure the law remains effective. The Hampton Roads Chamber of Commerce included COPN process reforms as a priority in its 2016 legislative agenda. In its Jan. 22 newsletter, the Roanoke Regional Chamber of Commerce expressed support for the work group recommendations, noting that “the Chamber believes that any reform should model the recommendations from the COPN work group to improve the quality and access to health care while also eliminating waste and abuse.”
The City of Virginia Beach, the Virginia Hospital & Healthcare Association, the Virginia Rural Health Association, and the Virginia Nurses Association also support COPN reform.
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