The status quo isn't optimal while full repeal of the certificate of need law isn't feasible, writes Andrew McNeill of KYFREE. "Every stakeholder in the CON conversation ought to be open to the idea that finding common ground is not only possible, but desirable. Greater access to quality health care for our families and loved ones should motivate our best effort to get there."

Meaningful reform on controversial issues takes time and hard work. Passions run high.? Sharp elbows get thrown. Nuance can contradict ideology, requiring compromise.

Which brings me to Kentucky’s certificate of need (CON) laws.

CON regulates investment in our state’s health care sector. Before opening certain types of facilities, an entrepreneur or health care provider must demonstrate there is a “need” for the services. The process is complex, it can be expensive and, at the end of the day, there’s no guarantee an applicant will get the go-ahead to move forward.

What to know about the certificate of need debate in Kentucky

Giving the government a veto on whether someone can open a business is the antithesis of free enterprise. Then again, health care is unlike any other sector of the economy.

During the 2023 interim, the General Assembly appointed a task force to evaluate the issue.? Legislation to reform CON was filed in the ’24 session but didn’t get traction. In June, the Licensing & Occupations Interim Committee dedicated their first meeting to the topic.

Smart people from all sides have debated what steps, if any, lawmakers should take to modify our certificate of need program. The gap between the positions is wide but that doesn’t mean it’s insurmountable.

Here are four guidelines to reset the conversation around sensible steps for CON reform:

Increasing access to quality health care is the goal.

Call it “CON reform” or “CON modernization,” the goal should be the same. Changes to CON must make it easier to invest in facilities and technology that provide health care services to Kentuckians. This will mean new entrants in certain areas but must also mean streamlining the red tape that hinders existing providers from expanding access.

Kentucky’s?health care market is actually many distinct markets.

Recognizing the differences between the state’s urban and rural health care settings is crucial to evaluating the policy options to reform CON. Nearly half of Kentucky’s acute care hospital beds are located in only five counties. Specialized in-patient services (cardiac, psychiatric, neonatal, etc.) are mainly — though not exclusively — concentrated in Lexington, Louisville and Northern Kentucky. On the flip side, we also have 25 rural hospitals —which provide essential care to thousands of our fellow Kentuckians — that have 25 or fewer beds.

Respect concerns from rural legislators.?

The connection between Kentucky’s smaller communities and their local hospital is more than a transaction. Knowing care can be provided close to home is a great comfort to patients and their families. Rural legislators are unlikely to support anything that risks a hospital closing in their district, no matter how small that risk might be.

Significant progress is possible through incremental steps.?

In 2018, a CON reform exempting several outpatient categories of care passed the legislature with broad support. Pragmatic changes can move the needle if the give-and-take of the legislative process works properly.

A family member recently developed a health condition that required a short hospital stay in Maysville, my hometown. I spent three days in that setting watching the nurses and doctors provide excellent care. The experience provided me with greater clarity on the CON debate than any report I’ve read or testimony I’ve listened to.

The status quo isn’t optimal while full CON-repeal isn’t feasible. Every stakeholder in the CON conversation ought to be open to the idea that finding common ground is not only possible, but desirable. Greater access to quality health care for our families and loved ones should motivate our best effort to get there.

"If this commission was truly interested in an all-of-the-above approach to electric generation, why not designate a position on the executive committee from the natural gas industry? Someone with expertise in large scale solar installations? Maybe even the nuclear sector?" (Getty Images)

In late February, energy legislation (SB 349) that’s been promised from Senate President Robert Stivers, R-Manchester, arrived on the last day for bills to be introduced.

Discussing the measure on the Senate floor last week, supporters emphasized the legislation’s commitment to an “all-of-the-above” energy strategy. It’s a talking point many might buy — unless they read past the bill’s first page.

Truth is that the legislation would lead to unnecessary government overreach into energy policy. And, require Kentuckians to shoulder the costs of financial benefits directed toward a small number of coal companies, several of which don’t even operate in Kentucky.

Kentucky Senate’s pro-coal bill would burden ratepayers, make energy transition more chaotic

?The Energy Planning and Inventory Commission, or EPIC, would be an 18-member group drawn from Kentucky’s business and energy sectors. There would also be an executive committee, which would wield the commission’s real authority. The authority granted to this new bureaucracy is unprecedented.

For example, if an electric utility plans to retire a power plant that has reached the end of its useful life, the utility is required to provide a one-year notice to EPIC’s executive committee before initiating the regulatory process already required through Kentucky’s Public Service Commission (PSC).

?That notice will trigger an expensive, taxpayer-funded report to examine a set of issues that have little to do with the provision of reliable and affordable power and, heretofore, haven’t been necessary for the PSC to do its job. According to the bill, the report “approved by a majority of the members of the executive committee shall be designated as findings of the (whole) commission.”

The five members of the executive committee include the head of the University of Kentucky’s Center for Applied Energy Research? and two members selected by the other commission members. A retired utility executive has a spot on the executive committee.?

Finally, the fifth member must have the “professional experience … required to serve as chief executive officer or board member” of a coal producer.

This is where the bill’s sponsors start hiding the ball.

If this commission was truly interested in an all-of-the-above approach to electric generation, why not designate a position on the executive committee from the natural gas industry? Someone with expertise in large scale solar installations? Maybe even the nuclear sector?

Kentuckians are being told EPIC is needed to focus on reliable and affordable power. But the legislation doesn’t mandate an executive committee member that speaks for consumers or someone who understands the complexities of regional grid transmission.

When asked if Joe Craft, CEO of Alliance Coal and GOP mega-donor, was consulted on the legislation, Senate President Stivers said that Craft was one of many “engaged in the discussions.”?

While others may have been involved, the legislation was clearly written to favor coal operators like Craft.

Frankfort has always been protective of coal. For decades, that aligned with providing the lowest cost energy option for Kentuckians. But that has changed.

Federal regulations have made — and will continue to make — coal-fired generation more expensive than natural gas.

As much as I’d like to see coal prevail in the ideological war that’s been waged against it, moving forward with an orderly transition to natural gas for baseload power is in Kentucky’s best interest.

A new state bureaucracy isn’t the answer to the attack on coal from Washington D.C. Kentucky’s attention should be focused on winning that battle in the courts. SB 349 does nothing to support that fight.

The legislation was fast-tracked out of the Senate. The House still has an opportunity to stop the General Assembly from picking winners and losers.?

Here’s how to start that conversation: “Kentuckians want our coal industry to succeed. However, Kentucky’s ratepayers shouldn’t have to pay excessive energy prices to prop it up.”