Since 2014, Alabama’s overdose rate has more than doubled. The opioid crisis, fueled today by the near ubiquity of fentanyl, is unsparing. As the overdose rate shows no signs of slowing, it is obvious that Alabama needs more substance abuse treatment facilities. The sheer number of people in need makes this clear.
But opening such a facility in Alabama is nearly impossible, and already entrenched healthcare providers can prevent newcomers from ever opening their doors.
For example, Longleaf Recovery & Wellness has been trying to open a new 60-bed residential addiction treatment campus in Shelby County, which lacks such a facility. But Bradford Health Services – the biggest player statewide – has been preventing Longleaf from opening. According to a recent report, the new facility would be one of only a few options for commercially insured Alabamians that Bradford doesn’t run.
Bradford has been fighting Longleaf’s proposal since the beginning, even though Alabama health officials acknowledge a shortage of substance use treatment beds across the state. Bradford’s Birmingham Recovery Center refers more than 40 patients out of state for monthly residential treatment.
How is it possible for a health care provider to prevent another from entering the market? Alabama’s certificate of need (CON) law grants existing providers a “competitors veto” allowing them to object to new providers applying for a certificate of need. In Alabama, established healthcare providers like Bradford use CON laws to protect their monopoly status; they stifle competition for their own gain. And if some Alabamians must leave the state for treatment because there aren’t enough beds, well, that’s just the cost of doing business.
Alabama’s CON law doesn’t just give healthcare providers the means to prevent new facilities from opening. They also force new providers to prove to the government that they are needed before opening their doors. While conventional wisdom suggests that more beds are needed and that competition is necessary to combat rising healthcare costs, Alabama law still ties new providers in red tape.
It’s tempting to pin all the blame on Bradford. In reality, the government shouldn’t be in the business of picking winners and losers, especially for something as important as health care.
Alabama's legislators are responsible for fixing this problem, and their constituents are suffering the consequences. CON laws do not benefit patients. Instead, they artificially suppress the growth of the healthcare market, contributing to increased prices and decreased access.
Alabama should follow the lead of states like South Carolina, which, in 2023, repealed all CON laws for healthcare providers except for nursing homes, resulting in new facilities and treatment options for South Carolinians. In 2024, Georgia and Oklahoma repealed CON for substance abuse treatment facilities.
These are just a few examples. The tide is shifting against CON laws across the country, moving towards greater liberty in the healthcare market. Around 4 in 10 Americans currently live in states with either no or minimal CON laws. And overwhelmingly, the research suggests they are better off.
Legislators in Alabama should act immediately to cut the red tape strangling the healthcare market and repeal its CON law. Alabama shouldn’t reward monopolies and punish its citizens with bad policy.
Jaimie Cavanaugh is an attorney and state policy counsel and John Sweeney is a state policy analyst at Pacific Legal Foundation, a public interest law firm that defends Americans’ liberty against government overreach and abuse.
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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