Reproductive Care News & Certificates of Need
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Reproductive Health News
Denial of Care
Remember the story we reported earlier this year about a pregnant person in the midst of miscarriage being given a bucket and towels and told to leave the hospital because they would not manage her miscarriage. This was in California and the hospital system was Providence.
California Attorney General Bonta sued them for denial of care. Here is a link to the State of California’s site. The hospital has stipulated that while the suit is in court they will not make matters worse and continue to flaunt the law.
Specifically, Providence will allow its physicians to terminate a patient’s pregnancy whenever the treating physicians determine in their professional judgment that failing to immediately terminate the pregnancy would be reasonably expected to place the patient’s health in serious jeopardy; result in serious impairment to the patient’s bodily functions; or result in serious dysfunction of any bodily organ or part of the patient.
Elections
The election was certainly a disappointment but I wanted to share a little good news about the abortion measures.
Voters backed abortion rights in seven of the 10 states where the issue appeared on ballots Tuesday — at first glance, seemingly reshaping the nation’s patchwork of abortion rules.
Colorado, Maryland, Montana, and New York — states where abortions are already permitted at least until fetal viability — all will add abortion protections to their state constitutions.
Nevada voters also favored protections and can enshrine them by passing the measure again in the next general election. The biggest changes came in Arizona, where, in 2022, abortion was banned after 15 weeks, and in Missouri, which has had a near-total ban. Voters in those states approved constitutional amendments to protect abortion rights through fetal viability, opening the door to overturning those states’ restrictions and increasing access to abortion services. (KFF)
WARNING
The election wins of Donald Trump as president-elect and Republicans in the U.S. Senate, giving their party control, have raised the question of whether a national abortion ban will be on the table. Lot’s of elected Republicans want that.
Certificates of Need (CON)
A CON is a regulatory tool primarily designed to control the number of health care resources in a given area. It is sort of like zoning for healthcare.
At its core, it requires a hospital or health system to obtain approval from the state before establishing or expanding a health care facility or service by demonstrating a need for it. Historically, the theory behind CON was that by managing the volume of health care resources available in a region, policymakers would be able to mitigate overuse of health care services and thereby contain health care costs for patients, payers, and providers.
Congress enacted the National Health Planning and Resources Development Act in 1974. At the time, Congress had documented that previous infusions of federal funds to the existing health care system had contributed to inflating costs while failing to provide an adequate supply or distribution of resources.
The National Academy for State Health Policy’s (NASHP) 50-state scan of CON laws shows which facilities are subject to CON, the range of activities that trigger a CON review, and the information considered during review. CONs come into play when there is a change of ownership, significant modification to a facility or when services will no longer be offered. Of course, the rules vary by state. There are 35 states that use CONs. 28 of those states apply them to hospitals. 9 states require a review when services are eliminated or substantially changed. 13 require review when ownership of a facility or large practice is transferred.
Here is a list of states that still use certificates of need:
Alabama, Alaska, Arkansas, Connecticut, Delaware, District of Columbia, Florida. Georgia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nebraska, Nevada, New Jersey. New York, North Carolina. Ohio, Oklahoma, Oregon, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, Washington, West Virginia.
What’s the Problem?
The government is deciding who can be your provider in your county.
If all the facilities in your county are religious (Catholic or other) they can choose not to provide certain services. Those services include contraception after giving birth, when the risk is low, death with dignity, any gender affirming care and more.
Washington state has 50% of it’s hospitals run by “religious” organizations. Some counties have assigned all the available hospital beds (per certificate of need) to a Catholic hospital. It you are pregnant - look out - you may not be able to get miscarriage treatment, or contraception. At least one of our counties has all the hospice beds assigned to a Catholic organization - Death with Dignity is off the table for you.
Action - What We Can Do
The list of states with certificates of need in place is above. If you live in one of them, let your elected officials know they should abolish them and let patients have a choice about where to be treated. You can reach them here, https://www.usa.gov/elected-officials
Or use your cell phone to send a text message SIGN PQCKIJ to 50409 (RESISTBOT) to send this message.
“I am your constituent and I have learned that we are in a state that has a medical Certificate of Need program in place. Such programs limit how many hospital and hospice beds are in a given area. And because many are assigned to religious organizations that limits reproductive care, gender care and end of life care.
I want you to eliminate those Certificate of Need programs and allow new businesses into the neighborhood that will provide the services that people need and want.
Thank you.”
RESOURCES
Find My Elected Officials
Contact State and Federal Representatives - phone and email
Healthcare Advocacy (Us) Website
Our Newsletter resources including reproductive healthcare - Healthcare Advocacy Reading List
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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I t is my understanding that here in Northern KY the CON which enables a near monopoly by one hospital chain is what makes it possible for them to keep rates low and provide much charitable care. Can you please address this?
Thanks for your comments. Here is a link to an article in which the CEO of the Catholic hospital (as well as other execs) reply to those trying to abolish CON.
Erlanger becomes site of conflict over medical certificate of need - LINK nky
“He characterized St. Elizabeth’s as a “safety net hospital,” which is not an official, legal designation, but refers, instead, to St. Elizabeth’s policy of accepting all patients regardless of their ability to pay.
“Communities like ours greatly depend on access to safety net facilities like St. Elizabeth,” he said. “Certificate of need ensures that we’re able to provide these comprehensive, critical, top-quality services to the entire community. In fact, it’s only because of certificate of need processes that St. Elizabeth can be a safety net hospital. Without certificate of need, outside operators could come into our communities and cherry pick the most profitable services to offer.”
Most of the patients St. Elizabeth cares for are Medicare and Medicaid patients, he said, adding that the percentage of their client base on Medicaid matched the proportion of the region’s population on Medicaid, which he claimed fluctuates between 22% and 23%.”
It is telling that “Greg Proctor, a representative from the Kentucky branch of Americans for Prosperity, a fiscally conservative think-tank funded by Charles Koch, compared CON laws in Kentucky to “permission slips from a government board that hometown healthcare providers must receive if they wish to open new health care services or expand an existing service.”
I do recognize the paradox that this gives a Catholic healthcare operation a market-dominant position which is to the disadvantage of women’s reproductive rights.
So again I wonder if indeed there are two sides to the CON debate.
Regards,
Frederick Warren