OPINION: Why Alaska needs to repeal its outdated Certificate of Need laws

Years of conversation about high prices and spending on health care in Alaska have produced many suggestions, but few have been acted upon. One solution that lawmakers are now considering is repealing Alaska’s Certificate of Need (CON) laws, which distort health care services and demand in Alaskan communities. As Alaskans with more than 60 years combined experience in health care, we have been watching these developments with great interest.

The federal government originally mandated CON laws for all 50 states in 1974 but backtracked by 1987. Such laws require health care practitioners to prove to state bureaucrats that building a desired facility, expanding an existing facility or deploying new equipment is necessary for a community. The process is lengthy and expensive, and it prevents providers from responding to the needs of their patients in real time. At least 15 other states have almost completely repealed these outdated laws — why is Alaska clinging to them?

The federal government initially mandated CON laws with the intention of decreasing health care costs, but dozens of studies have found their effect to be the opposite. In 2017, economists found that repealing CON laws would save Alaskans $294 in health care costs per person every year, so the annual savings could be in the thousands for families. That per-capita average has surely increased by 2022.

Additionally, repealing Alaska’s CON laws would give health care providers more flexibility to respond to the current needs in their communities and secure for Alaskans greater access to better-quality care. To respond to the COVID-19 pandemic, Alaska, along with 24 other states, temporarily halted some CON laws. Patients should have the same opportunity for responsive care all of the time. Global pandemics aren’t the only change to which providers must be able to adjust.

Other previously suggested reforms could help roll back government control of our health care and allow a better understanding of Alaska’s high costs, such as direct care and an all-payer claims database (APCD). Direct care removes unnecessary government control of health care and puts patients in a direct relationship with the doctor of their choosing. Protecting direct care in Alaska would give patients more health care choices that are affordable and high quality.

An APCD could improve care and lower costs by giving Alaskans more comprehensive data about health care prices, spending and quality around the state. The caveat, however, is that any such database must not become merely a new financial burden on the state budget.

For too long, our communities have been bearing the burden of government control of health care, with higher prices and lower-quality care. Alaskans deserve affordable, quality health care, without the heavy hand of government interfering. This is the year Alaska should stop just talking about the high cost of health care and do something about it: repeal CON laws, protect direct care and make necessary care more affordable.


Stephen Becker, M.D., is an orthopedic surgeon with more than 34 years in practice.

Leslie Becker has 30-plus years’ experience as a health care executive with working with large hospital systems.

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