Legislative efforts to do away with North Carolina’s Certificate of Need (CON) law took a path less traveled by this short session. If enacted, it would be pretty epic to say that it all began by having a few senators gut a House bill’s language to adopt the bobcat as the state’s “official cat” and replace it with a full-blown repeal of CON by 2021. Now that is what you call a proposed committee substitute. And, yes, it’s legal.

Last week, the Senate Health Committee held a meeting in which HB 161 was not up for a vote, but rather a discussion among members followed by a public comment period. As predicted, the proposal runs into the usual pushback voiced by the usual Democrats and Republicans. The Carolina Journal reports:

“I think that total repeal is unnecessary,” said Sen. Floyd McKissick, D-Durham.

“I think it will have a terrible impact, particularly on small hospitals, rural hospitals,” because smaller clinics will open on their periphery, he said. “They will drain patients from the most profitable services a hospital provides, but unlike hospitals they would not be open round-the-clock, or be required to provide charity care.”

Will a complete repeal of CON force hospitals to close in rural areas? After all, one of CON’s basic principles is to protect rural health care. Members of the state health care planning division are responsible for ensuring equitable access to certain types of health care facilities and services in underserved areas of the state. Not too many hospital beds, not too few kidney dialysis units, but just the right amount of MRI machines. The same formula applies to neonatal intensive care units (NICUs), long-term care facilities, gamma knives, same-day surgery centers, hospice, home health, organ transplants, mental health services, and more…

If you think CON upholds rural health care, think again.