I AM writing to express support for Virginia’s Certificate of Public Need law. The COPN law protects and ensures all Virginians’ access to essential and high-value health care. The core of the law is the recognition that many preconditions for an effective free marketplace just don’t exist for health care.

Name one other “free market” where service providers are required to provide free service to large numbers of customers, and accept payment that is more than 30 percent below costs for many other customers. Yet that is what hospitals are asked to do. It is their obligation and they take great pride in that.

In 2013, Virginia’s hospitals provided over $628 million in charity care, enabling some of Virginia’s most needy to get access to health care, and absorbed more than $339 million in Medicaid losses. During 2014 on a local level, Mary Washington Healthcare provided more than $27 million in charity care and absorbed more than $16 million in Medicaid losses.



In addition, combined cuts imposed by the Affordable Care Act, sequestration under the Budget Control Act of 2011, and the American Taxpayer Relief Act from 2013–2016 are estimated to be almost $1.4 billion to Virginia’s hospitals. One third of Virginia’s hospitals operated in the red last year, and bond rating agencies are forecasting an even bleaker outlook for 2015.

The Certificate of Public Need law is important to all Virginians because it ensures:

1) Access to care for the uninsured and less fortunate;

2) Availability of essential health services for everyone;

3) Readiness for public health and disaster care needs;

4) Training the future health care workforce; and

5) Quality of care oversight and accountability of all health care providers so consumers know they can trust the health care that they receive.

In 2000, the Virginia General Assembly passed a bipartisan law to responsibly deregulate COPN. As necessary pre-conditions for phasing out the law, certain protections were put in place to ensure access to essential services, health professions training, disaster preparedness, safety net health care, quality of care oversight and accountability, and market fairness. Unfortunately, a lack of funding to address these necessary pre-conditions put the deregulation plan on hold.

The need to ensure access to essential health care services and indigent care is even more critical in Virginia today. Regardless of one’s opinion about the ACA, if Virginia joined other states in implementing our own approach to covering the uninsured, an estimated 250,000 more Virginians would receive insurance coverage, and one of the most critical requirements for an effective health care marketplace could be largely addressed. However, in the absence of a path forward on coverage, COPN deregulation risks destabilizing an already fragile health care system and jeopardizes the ability of all Virginians to receive access to vital health care services. Further, it is imperative that Virginians know the health care they are receiving is safe and well-regulated to ensure their own personal health and well-being.

All of this is why any conversation about reforming or eliminating Virginia’s COPN law must start with a comprehensive, responsible plan that takes into account the need to protect the ability of all Virginians to receive access to essential health care services, including our most vulnerable citizens, while also ensuring that when we access that health care it is safe, well-regulated and of the highest quality.

Michael McDermott, M.D., is president and chief executive officer, Mary Washington Healthcare.

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