Believe In Arkansas
Believe In Arkansas
Talking with Hannah Cox: How Arkansas Certificate of Need Requirements Limit Access to Mental Health Care
Ryan's guest is Hannah Cox, an up and coming free thinker in the liberty movement. Hannah co-hosts Based with Hannah Cox and is frequently seen on Kennedy Nation on Fox News Business.
A Certificate of Need is required in order to construct a new healthcare facility. In order to obtain a CON, developers of healthcare facilities must apply to the local governmental authorities by making the case for why the community in question would benefit from that new development. Today we’ll be looking at why Arkansas should address this often needless barrier to health care, particularly mental health care.
With Arkansas Ranked 48th nationally (United Health Foundation 2021), Hannah, a former advocate with the National Alliance on Mental Illness, discusses how CON barriers unnecessarily limit choices for mental health care patients.
Americans For Prosperity – Arkansas is a non-partisan, non-profit, public policy organization of citizen activists committed to maximizing the innovation of free citizens to solve the serious problems facing our state. To learn more about our chapter and see how AFP can help you or your organization increase your impact in our state, email us at infoar@afphq.org
To learn more and see how AFP-Arkansas can help you or your organization increase your impact in our state, email us at infoar@afphq.org or visit us at believeinar.com.
Welcome to believe in Arkansas, where we believe free people are capable of extraordinary things. Now, here's the host of Believe In Arkansas, Brian Norris. Welcome back everyone to believe in Arkansas, where we believe that free people are capable of extraordinary things. And I'm extremely excited as I am every segment that we have to talk about a topic that many people don't know about the restricts their liberty restricts their choices on a day to day basis, particularly in the instance we're talking about in the areas of healthcare. So today's topic that we will be talking about our certificates of need, and how outdated and how unusable that these are, and that they're actually barriers to healthcare issues. And the conversation that we're going to have the day is with Hannah Cox, Hannah is a libertarian conservative and political activist, I consider to be one of our up and coming free thinkers in the liberty movement. She's a commentator and also a writer. Her work revolves around the defense of individual liberty, free markets and limited government. And Hannah's focused or advocacy on bidding back big government in defense of individual liberty, and finding free market solutions for society's most pressing problems. So without further ado, Hannah, thank you so very much for joining believing Arkansas.
Hannah Cox:Well, thanks for having me, Ryan. And thanks for that introduction, they very kind,
Ryan Norris:well, hey, I'm a little bit I'm a little bit of a fanboy. I've been following you on Twitter for quite a while now. And I appreciate it, particularly your consistency in applying the principles that you believe in to everyone in a very unique, very honest way. You know, intellectual consistency, and honesty is kind of a thing that you don't find in mass media particularly. But I always appreciate that you, you, you apply it to both sides equally on this. So you don't let anybody get away with anything when it comes to small government, free free market approaches. So I appreciate that for you.
Hannah Cox:Well, I appreciate that. And I think Americans for Prosperity is an excellent organization, you guys were actually the first organizations I ever encountered when I was first getting involved in politics and really have helped me kind of connect those principles to public policies over the year. So it's excellent to be with you and just really admire all the work you guys do as well.
Ryan Norris:But you know, Hannah, the organization at large and here in Arkansas, the reason we call it Believe in Arkansas is because we believe that, like we say free people are capable of extraordinary things, and that individuals have the best solutions to problems that they face, if we would just remove the barriers out of their way. And, you know, on a daily basis, we're seeing choices eroded away, liberties eroded away for people. And they don't many times even know why it is the way that it is. Or, you know, why is it that, you know, I can have have the car in any color, as long as it's black? You know, to paraphrase the old Ford adding little anecdote there. But, you know, we get we get really involved on the big ones, you know, it could be a gun rights issue that, you know, is in the public conscience again, now, the issue of free speech, the issue of assembly, etc, taxation even, but when it comes to some of the basic regulatory items, that 1000s are, are, are added on a nearly monthly basis or a yearly basis. It just totally erodes away your freedoms.
Hannah Cox:Yeah I think that's absolutely right. It's one reason I launched my show based a number of years ago, because as someone who's really kind of operating outside of the two party system, and then somebody who works on, you know a lot about partisan issues, because I really am focused on things that are consistently free market capitalism, limited government, individual liberty, that's allowed me to work with people on both the left and the right. And what I learned throughout that experience is that we're often not as far apart as the mainstream media or the culture might make us feel I think oftentimes, we agree on many of the really big pressing problems in our society, like health care, like criminal justice reform, we know there's a problem. But I think the difference is a lot of people do not have the institutional knowledge to know what created those problems. They don't understand how the government has infringed and various sectors of our economy, they often are led to believe that we are a quote unquote, capitalist country. And so they therefore think anything that happens in this country is capitalism right now, oftentimes, the problems that we have are created by anti capitalist public policies pushed by our government, both the federal and state levels. And so I think as much as we can help people understand the root causes of issues and really kind of come together on the ground. What created the problem in the first place, the more we can Then build consensus on the solutions. And right now instead, what we often see happening is people trying to prescribe solutions for problems they don't even understand the root cause of and oftentimes those solutions are actually what created the problem in the first place. And so we've got to have those conversations.
Ryan Norris:Yes. To your point about people getting involved on the, on these issues. I was listening to Joe Rogan podcast recently with Russell Brand. And he said something that really resonated with me said, he said, people want to be involved in the power systems that affect them. And people really aren't, there isn't as much participation in the political processes, and then even less in the rulemaking processes or the regulatory processes. And that brings me kind of to our topic, something that many people don't know about, that they care about health care, they want more health care, more access to health care, but they don't understand why they don't get the health care they need, when they need it at a price that they can afford. And one of those restrictions are the certificates of need. I know you've worked on this, could you explain to the audience a little bit of a primer on what certificates of need are?
Hannah Cox:Oh, I'd love to when I first started working full time on public policy was 2016, I was working in Tennessee, and certificate of need was brought up to me then I was at the Beacon center of Tennessee, and they told me we were going to try to repeal some certificate of need laws. And I you know, I was like, what is that. And when they told me it was so bad, I thought they must be joking, I truly couldn't believe it. But certificate of need are these logs that were implemented throughout the 70s. And they are I mean, they are just blatantly put in place as a protectionist measure meant to basically shield industry insiders from competition and to keep prices artificially high in health care. And they were put in place both the federal and the state level and on most of the federal ones have been done away with, they still have a plethora of them across different states. And they look different, you know, depending on where you're at, but they always have some similar components. And that is that in order to add new services within healthcare, new supply, so that could be beds, that could be pieces of equipment, that could be facilities, you basically have to go in and argue before this government kind of supported board about why you quote, quote, need it. And then your competitors get to come in and argue against you and argue why you don't need it. And so typically, what you see is the large hospital conglomerates come in and work and lobby against the smaller, more independent competitors, and then basically prevent them from being able to increase their supply in the market. And this allows the larger companies to keep you know more of a monopoly over the services, it also allows them to have way more sway than they should in determining prices, because they do have less competition. And as a whole, it restricts supply. And this is just basic economics 101, when you have a restriction on supply, and demand stays the same or increases that has been doing in healthcare in this country with population growth and an ageing Boomer population, that means the price has to go up. And that's really good for the certain number of industry insiders in politics. But it's really bad for Americans as a whole. And this is a big reason that a lot of Americans cannot get the services they need or cannot get the services they need and affordable and timely manner.
Ryan Norris:Yes. And to that point on the cost reduction argument that they say are the intention, the question is has lived up to its intentions. And you can look at the year over year increases in healthcare costs. And you can look at what you know, the decreases in quality of services, particularly in rural areas, that this was allegedly supposed to solve for those kinds of things, but it definitely does not, in fact, it also I would argue, stifles innovation, and is just not really as cost effective for the taxpayer, particularly because the only solution usually brought to the table in the costing side now is some kind of expansion of government funding, you know, like Medicaid expansion. And in I think, and I think you would somewhat agree, definitely probably agree that the free market could solve for that, that there are probably ideas on how to bring lower cost health care to areas that are underserved, then just increasing the funding that we take out of the economy to put into those spaces.
Hannah Cox:Yeah, I think that's absolutely right. And I you know, when it comes to certificate of need, my personal opinion is you have public policies that were put into place with good intentions, and that just go arrived because of the failures of central planning. And because oftentimes, you just have people writing public policy that don't fully understand the ramifications of it. I personally don't believe that's the case a certificate of need, I think certificate of need was always intended to actually limit supply and to shield industry insiders. Now, that's not what they're going to say to the public about these laws. But that is certainly I think the intention of them and I think they are working exactly as intended. And this is something we're largely it does hurt the poorest among us, it hurts people who live rurally it hurts people who cannot afford to wait for services and who can't afford to travel long distances for services when there is not more so ply. And so I really think that we have to start having an honest conversation about the way that we approach healthcare and really looking to deregulate it and ensure that the really only role government has to play is to ensure public health and safety, right. And there's nothing about certificate of need that does that it is plain old central planning, it is trying to, you know, play God and determine what people need before they need it. It's extremely anti capitalist, it's not a free market approach to anything. And it's something that at the end of the day really hurts people. So what we need is for the market to be able to respond to demand and for doctors and people who own hospitals and people who produce equipment to respond to those market signals in a timely manner. And certificate of need prevents all of that,
Ryan Norris:right, that's the arguments that that we bring to this discussion is, you know, this isn't a decrease in the quality of care or quality of care, as in regards to, like standard licensing and training requirements, you know, those still stay in play, it's just now allowing for those that have those licenses and have the training, that maybe have an innovative idea on how to bring it to the market in a way that, you know, again, is lower cost, quicker, better access, that they can, they can come into an area and actually attempt to bring those services to the people. And Cons are those walls that basically create a monopoly for the select few who have those licenses in a state. You know, and there is also the conversation about the poor, and those that can't pay for health care services. And there's sometimes this quid pro quo that goes on because they say, Hey, we're gonna give you the con licenses, but you have to take a certain amount of care and have it to petitioned away and set aside for taking care of those that that are lower income. And they're even in math, it's shown that there isn't a correlation in the research between certificate of need, and an increase in services to the pool. So nearly every argument that is brought up to support time, they research in reality, do not bear those out as being the results.
Hannah Cox:Yeah, I really liked that you bring this up, because objectively looking at all states, that has to be a meeting, comparing them across the board to say that do not they have worse health care outcomes at large, right. It's not just for the poor people. I mean, that's absolutely true that it does not provide better services or an increase in supply for the poor. But also, it we see that in states that have this we see worse outcomes for diabetes, for heart disease, for mental health services, it is a whole is something that prevents people from getting the care they need. And then when it comes to health care, you know, a lot of people can't afford to wait, they need timely care, they need to be able to see the scene quickly. They don't need to be able to have to wait months and months to see a specialist. These are things that are really quite serious and can be even life and death matters. And so as a whole, we just see con overburden the system put barriers in place that are time consuming, that costs a lot of money, and that delay people from getting care. And it's actually something that I think is gross negligence on the part of our politicians that continue to allow it to stay on because the research against con I mean, there's there's it's infallible, there's nothing that goes against this, it shows across the board that it hurts people. Right. Right.
Ryan Norris:Right. And so here in Arkansas, and we have six certificates of need, and one of them that AFP Arkansas is really interested in because we think that this definitely is an issue that has been exacerbated by COVID is psychiatric services, particularly psychiatric residential treatment facilities here in our state, we have a certificate of need, that since 2008, no one's been able to actually apply for one. And even those that have them. They are limited. In fact, there's a moratorium on adding new beds. So this has created an interesting problem to where our definitely our supply is way less than the demand for these kinds of services. You know, and so my question would be to, you know, how do you think the issues of certificate of need requirements in health care in like most states, in fact, the individual liberty and health care markets and, you know, we kind of in general here, you know, in Arkansas, it's limiting
Hannah Cox:was very limiting. And I actually find this law in Arkansas to be one of the more insidious under certificate of need, and that might be because of my proximity to the mental health community and the work I've done on it, but I'm somebody who's always been very, very passionate about mental health care and very hyper aware of the fact that the right has often not had the answers to it that it should. Back when I was first getting involved in politics in Tennessee. I actually took a pro bono job lobbying for the National Alliance on Mental Illness because I was that passionate about it and I I went to them I said, you know, I'm not gonna be with you on everything. I'm not in favor of expanding government control over health care, which sometimes you will find mental health advocate As our but I'm very passionate about finding free market responses to mental health care and finding ways that we can provide an expansion of services to people in a market capacity. And as I was doing that work, you know, some of these kinds of issues were being revealed. And it really is a very big problem, we simply are already at such we're coming from behind the eight ball when it comes to mental health services, we are so behind in the sector of health care in this country, both in just terms of research and development of what we know about mental health care. But then also in terms of supply, we have a drastic shortage for providers. And when it comes to mental health care beds, that is one of the biggest obstacles we face in getting people the treatment that we need. Now, when it comes to the bed issue. This is why I call Arkansas law so insidious, because this it really is life and death, when somebody needs a mental health care bed. It is typically not because they are having a rank and file episode of depression or anxiety, it is typically a much higher stakes situation, that point they're typically having some kind of psychotic episode, they might be having, you know, schizophrenia episodes, they might be in a state of paranoia, they might be very suicidal, I can't say what all those situations would be. But we know that this is something that, you know, the stakes are a bit higher than they would be for basic mental health care services, people need to get a bed, and they need to be able to get it very quickly in the circumstances, they typically arise kind of out of the blue. And right now we have a drastic shortage of beds across this country. But specifically and more red and rural states, we see the shortages. And so this is something where people largely cannot get the care that they need within mental health care, and it does cost lives and it has all kinds of other repercussions on society. Because when somebody is in psychosis or having a psychotic episode, and they can't get a bed and they can't get care, we see then then perhaps commit episodes of domestic violence or other kinds of violence, we see that trickle through our criminal justice system. And so it's not even a contained incident when people like this cannot get the care they need.
Ryan Norris:Right. Well, it will probably be not a surprise to you that some of our coalition partners on on this issue of of psychiatric residential treatment facilities on CON repeal are in the space of criminal justice reforms because they're, they're looking at it as we can incarcerate them with no care, no real health, or we could potentially utilize these services as a way of keeping them safe, keeping those around them safe. This believe in Arkansas shout out goes to Lorenzo Lewis and our friends at the confess project, the first and largest organization committed to building a culture of mental health for young boys and men of color through barber shops across the country. Lorenzo is an Americans for Prosperity partner who informs our health care policy goals by identifying the policy barriers to mental health care services for all Arkansans. One in five people in the US are affected by mental illness, and black barbers play an essential role in bridging the gap between their communities and unmet mental health needs and mental health care. Learn more about the good work that Lorenzo and the Confess Project barbers are doing in Arkansas, and across the country by going to theconfessproject.com That's theconfessproject.com A quote real quick because you hit on several of these from Arkansas Children's Hospital CEO recently, one of the one of our top institution, medical institutions here in the state said mental health care disorders now account for nearly 2.5% of emergency department visits at the Little Rock based Arkansas Children's Hospital 150% increase from pre pandemic levels. And the quote goes on, say inpatient facilities are full, and they're strapped for space and staff. And the length of time it takes to transfer a child to the appropriate inpatient setting is 50 to 75%, longer now than it was 18 months ago pre pandemic, and that hits on all the points that you're talking about. We've artificially restricted this service. It's in it the all of a sudden, overnight due to COVID. And all the different problems that have arisen from that regarding mental health. The service has gone up 150% increase in one facility for this service, and they're having 50 to 75% longer time in, in someone that needs that crisis care now. They're having to wait longer and longer to get them into care. And I find I find that unacceptable.
Hannah Cox:Yeah, and I think it's important that you mentioned just how frequently these episodes are occurring. And kids, you know, we've seen a growing epidemic of that in our country, specifically during COVID. We've seen a big spike in the mental health episodes that they are having and the need for them to be able to get timely mental health care is especially important. And I think that this is something that we can do something about very quickly, right? It does not have to be this way and and you would not see this happen barring government because in free market capitalism, the market would respond to this demand. It's plain and simple. It's done. dollars and cents the market wants to respond. And the only reason it cannot right now is because it has its hands cut behind its back due to the certificate of need laws that again, do nothing but try to enrich a certain number of people in the healthcare system. And it's just frankly corrupt.
Ryan Norris:And so in looking at the totality of mental healthcare, in Arkansas, particularly among for our children, youth mental health care, were 48th in the nation, according the United Health Foundation, 2021 annual health rankings 47th in the nation, according to mental health, American 2021 rankings. And so 48 - 47. Again, there at the at the back end of this, and a ancillary problem to this is the need for more health care professionals. But this is not going to come as a surprise, again, Hannah, but Arkansas has some very restrictive licensing and the ability to obtain licensing for mental health care workers. In fact, we are one of the states that does not recognize out of state licensees from coming in and helping us out. And one of those issues may be that they look at con and they say I would love to go in and help Arkansas. But the market is basically blocked to me from being able to even come in and help even though I know that Arkansas needs it.
Hannah Cox:Yeah, I think that's an excellent point. You know, when we look at, even within travel nursing, I have friends that have been doing this for a while, they look at various factors about states, you know, in determining where do I want to live for a short period of time? What kind of amenities? Do they have to draw me there? Or how hard is it to get licensed there? How hard is it to actually start making money there. And so those are factors that people have to take into account. And I think states, you know, certificate of need is an excellent thing to target. I think it's top of the totem pole. But there's a lot states need to do to start removing barriers to care. And that does include reducing the barriers to obtain a license making it cheaper, recognizing out of state licenses, allowing people to sell across state lines, it looks like expanding telehealth, I mean, if you look at some of these regulations that are in place, we do some really silly things that ultimately just prevent people from having access to care. But certificate of need, I think is really up there. Because it's it's at the top level, right, if you're a rank and file nurse, or doctor, there's not a whole lot you can do as an individual to overcome these barriers that were largely put in place by corporations and the government. So we have to remove that we need to get back to where people can have an actual relationship with their doctors and nurses, and again, where doctors and nurses can rise up and meet the demand as needed.
Ryan Norris:Right. And this goes back to the very first part of the conversation that these are laws, that they're not, they're not the big ones that that hit the the news every night. But these are laws put in place that restrict your healthcare access in real time, your ability to access care, or your ability to maximize your passion in health care to help people and, and people. We don't fight this often. It's not nearly as as as attractive and, and passion building. But when you find people that have been affected to where they said, Sorry, we don't have a bed for you, you're gonna have to go to another state, or, you know, because of the way this is here in Arkansas know, you'd like to start helping us with mental health care with your professional licenses. But we don't recognize Tennessee's license, we don't rest and recognize Oklahoma's license, you're gonna go through the entire process all over again, it'll be a year or two before you can get really, you know, to making any money here, no one's going to accept that. And I think that we need to band together as people say, hey, look, we're going to fight you to get back all of our rights and defend all of our rights on the big ones that are in enshrined in the Bill of Rights. And plus, we're gonna fight for all these to where government and business have colluded to the benefit of the few, but to the detriment of all.
Hannah Cox:Yeah, I mean, I've heard it referred to as we've criminalized compassion, you know, and we've really made it to where it's illegal to try to offer people care without jumping over these hoops. And I think it's something where politicians need to sort of grow a spine and stand up to some of the lobbying interests that have been pushing this for some time, because the people are behind you. And the people are starting to recognize as they learn more and more about these things from place, why things are the way that they are. And they recognize that largely, the government seems to be working for these conglomerates and not for them, the individuals and the patients. And there's only so long that Americans will put up with that. And I think we're kind of hitting a breaking point for many people where they're fed up. They're tired of their needs being put last and their representative government and they're starting to really try to push back on some of this you've seen, I think that's why so much animosity towards the pharmaceutical industry and recent years, so much animosity towards many people in the health care system at large by rank and file Americans. And so this is where the people are, this is what they want, I think is as they learn about certificates. And I often talk about my platforms and I can tell you firsthand, people are livid when they find out about this the minute they hear about it, I mean, left, right, middle, wherever the voters are, they are, they are so angry about this because it's so obviously corrupt and hurtful. And many people do know somebody who has been impacted by this myself, I had a cousin in Alabama who really needed a mental health care bed was having an episode of years ago and could not get one was going to be like a month and a half wait, he could have been dead by then had his family not been able to leave the state. And the reality is for many people, they cannot leave the state financially or take away time from their jobs to do that. And so the states have got to start figuring out ways to actually be accountable to the people and make sure that they can get these basic services.
Ryan Norris:Well, Hannah 100% agree. And now there are states that actually have her build their cones, and some of them, particularly cones that are for psychiatric services, chemical dependency, such as Mississippi, Tennessee, Washington State, and even Florida. And they haven't those states haven't for what I know, so far haven't checked recently. But they haven't spun off into the sun when the con was repealed. Do you have some examples of cons that you've worked on that that have been repealed? And the benefits that have come out of that?
Hannah Cox:Yeah, well, there's a lot of studies that have that have looked at states that have repealed it. I think that that's one of several from you guys. They have I think the Cato Institute has produced them, I don't have them right in front of me. But I know that like in looking at them carte blanche, across, across the whole average, these states have repealed CON, the sky is not falling out. And in fact, they have seen better outcomes. As far as the major health care issues that people face. I myself was involved in getting rid of a few in Tennessee, they do have a few left on the books, but we were able to remove a few. And that was a big boon for those sectors, I think they were able to start adding MRI machines that are having to go through this process and some things like that. So it's pretty easy to see that this is where the trend is moving. And we've also seen a lot of states starting to focus on this. South Carolina had the votes actually, they'll do a full repeal this year, their Republican governor was fully on board and actually sent out a letter talking about how this hurts innovation, talking about how this is really just protectionism. And it prevents competition, and it keeps prices artificially high. So I think in their special session this summer, they might end up getting it because the consensus is there. And I think that all that's left to be done is you know, getting the ball across the finish line, which can take time in politics, as everybody knows it. I always say, you know, politics flows downstream from culture, and it kind of takes a year or two to catch up. Sometimes the culture is there, this is coming. And I think it's inevitable. It's just a question of how fast states are going to move on it. And the reality is, every minute they wait, people die, people have have worst health care outcomes, they suffer because of that. So it's really time to get on board with this. And to just hurry up and get this done. There's really no arguments against it unless you're just in the pockets of these big pharmacy or big hospital companies that are trying to keep it to be totally
Ryan Norris:Well, I was going to ask you to give a message to frank. our audience and to legislators. But I think that what you just said kind of sums all of that perfectly. So the time has come for Arkansas to take a look CONs but particularly, you know, with one of our most pressing issues being mental health, we definitely need to look at any arbitrary restrictions to those services, our Arkansas again 48th in the nation, on mental health for our youth and psychiatric residential treatment facilities. They are the ones who provide services and patient services for the you know, for our youth and we we don't need to have these arbitrary rules in place that keep people from the care that they need. So if you're interested in getting involved, go to believe in ar.com, or email us at info AR and AFP hq.org. And we would love to collect your story to get you involved in the movement to repeal these cons on psychiatric services. And also on believeinar.com or believe in ar.com. You can watch a video by Lorenzo Lewis with The Confess Project. He is one of our catalyst partners who brings mental health care services via the barbershops in his community to those that are sitting there in the chair need a haircut no one knows you better than your barber usually. And he's does a great work in there. But he is on board with helping us repeal the certificate of need for psychiatric residential treatment facilities. So again, believeinar.com is where you can go for more information to watch the windows video and infoAR@AFPhq.org for just reaching out to the AFP, Arkansas team, and, you know, learning more about what we're working on in CON. Hannah. How is it that we can get connected to the work that you do you have an extensive body of work and adding adding things daily. So how can our audience learn more about the great work and volumous work that you were doing?
Hannah Cox:Well, thank you. I'd love to connect with folks. The best way is probably to head over to based-politics.com That is my company you can find all tons of articles and content and videos and podcasts and all kinds of information there on various public policy issues on social media. I'm @HannahDCox on those platforms, you connect with me there and I'd love to check out have people check out our podcast too, which is under bass politics on this podcast networks. It's my colleague and I, Brad Polumbo, we have a weekly show talking about a lot of these public policies. If you want to get a bit more in the weeds, check us out there.
Ryan Norris:Wonderful. Well, Hannah, thank you so very much for the work that you do and for being a partner with us and AFP and speaking here to our audience in Arkansas. We wish you the best and everyone remember that free people are capable of extraordinary things. Thank you for joining us for Believe in Arkansas, where we believe free people are capable of extraordinary things. If you believe in Arkansas and would like to help unlock our state's potential. Go to www dot believin ar.com to learn more and join the movement today.