For years, the nation has been plagued by an epidemic of addiction and despair. Access to recovery care is a literal life and death issue for many Americans, including those in Alabama. Unfortunately, when the government gets involved, it stands in the way of new treatment facilities that can save lives.
For the second time this year, Bradford Health Services filed a formal challenge to Longleaf Recovery & Wellness’ Certificate of Need application. Longleaf Recovery is attempting to open a 60-bed addiction treatment facility in Shelby County, a proposal approved by the Statewide Health Coordinating Council. Gov. Kay Ivey signed a state plan amendment authorizing it, while Speaker Nathaniel Ledbetter (R-Rainsville) and Lt. Gov. Will Ainsworth issued letters supporting the facility.
So, what’s the issue?
Unfortunately, Alabama has a process by which, to open a medical facility, you must obtain a Certificate of Need (CON). Alabama maintains 47 CON requirements, and the average cost of an application from 2014–2024 was $17,263. CON is essentially a requirement to prove to the government the need for a particular service in your area.
In short, CONs are extremely expensive permission slips health care providers must have in order to care for their patients. What’s worse is who a provider must go through to get that permission slip.
Alabama’s CON law dictates that to receive a Certificate of Need, you must go before an unelected special interest board, which then decides what health care is available to you throughout our state. In many states, these boards are composed of a potential provider’s competitors.
In the 1950s, Milton Roemer theorized that if hospitals had beds, they would be filled, and therefore beds would be in high demand and short supply. So, in order to reduce the cost of health care, you must reduce demand.
Limiting supply so that demand decreases? Anyone can see the massive holes in this logic. You reduce the cost of health care by opening the market to more options and competition. But CON requirements stand in the way of that basic principle.
And CON doesn’t just come into play if you want to open a new hospital, surgery center, or an outpatient addiction recovery facility (like Longleaf). Even adding more beds to an existing hospital requires a CON.
Bradford Health Services – owned by a New York private equity firm – is buying up health care facilities around the country, challenging competitor CON applications wherever they go. In Alabama, they’ve fought recovery centers in Morgan County, Mobile, and now Shelby County. They even acknowledge that Shelby County doesn’t have options for addiction recovery, but according to Bradford, there’s “no need for additional substance use beds.”
Despite Bradford deciding what is and what isn’t needed in Alabama, it appears an awful lot like the private equity firm is using blatant anti-competitive practices to maximize their profits at the expense of suffering Alabamians.
This isn’t just government red tape delaying care. It’s entrenched special interests using that red tape to protect their monopoly. Bradford Health Services, which already controls many of Alabama’s treatment beds, has filed another formal challenge to block Longleaf’s 60-bed recovery project. Their message to regulators is openly anti-competitive, claiming there’s “no need” for more substance use beds in Shelby County, despite the state itself adding those beds to the official health plan. Bradford has repeatedly used the CON process to keep new providers out, putting profits over people and delaying care for families who need it now.
Alabama has a serious lack of substance use beds as it is, with 20 treatment beds per 100,000 people, below the national average of 35. Yet organizations like Bradford prioritize monopolizing the industry.
Researchers estimate that, were it not for its CON law, Alabama would have an additional 52 hospitals, bringing the number up from 126 to 178. Patients would, on average, save over $200 a year in total health care spending if CON was repealed.
Roemer mistakenly thought that reducing the supply of health care would bring less demand. For those who know even the most basic premise of economics, the exact opposite was bound to happen, and it has. Rural Alabamians are suffering from the lack of health care, while costs remain sky high.
CON laws don’t only hurt those who need access to health care, they also regulate some health care providers and entrepreneurs out of the market entirely.
America is the greatest country in human history partially because of our idea that open markets can help solve problems people are facing. When innovation abounds and options are plenty, prices fall and businesses must compete, resulting in a thriving and better cared-for consumer.
It's past time to remove these antiquated, special-interest laws that keep needed care out of Alabama communities.
Adam Thompson is the State Director for Americans for Prosperity–Alabama.
The views and opinions expressed here are those of the author and do not necessarily reflect the policy or position of 1819 News. To comment, please send an email with your name and contact information to [email protected].
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