TALKING RICHMOND: Healthcare Costs and Legislative Fixes
Certificate of Public Need and BPOL are two issues that Del. Scott is addressing this term. Also, he provides information on tracking legislation and how to provide online testimony.
By Del. Phil Scott
HOUSE DISTRICT 63
Happy New Year to all reading. On Wednesday I am back in Richmond for Legislative Session, and I wanted to highlight a couple more goals for our District.
As a member of the Health and Human Services Committee, we are always looking to find good ways to lower healthcare costs. Lowering costs should be bipartisan, and I think we found some simple ways to make an impact on the state level.
I will be putting in a bill to limit the scope of Certificate of Public Need. The core flaw in COPN (and CON laws generally) is that it was designed to address a perceived market failure; uncontrolled expansion leading to overcapacity and inflated costs; but in practice, it creates anti-competitive barriers that exacerbate those very problems. Originally mandated federally in 1974 to contain costs under cost-based reimbursement systems, CON laws were intended to prevent duplicative services. However, after reimbursement shifted to fixed payments (e.g., via Medicare’s 1983 prospective payment system), this rationale collapsed, yet laws persist in 35 states, including Virginia.
The flaw is structural: COPN assumes government can better allocate resources than markets, but it often leads to capture by powerful stakeholders, undermining its goals.
The bill I will be proposing, in essence, is a targeted deregulation aimed at small, independent ambulatory surgery centers (ASCs), which are outpatient facilities focused on same-day procedures like cataracts, colonoscopies, or joint surgeries. This aligns with broader trends in states like North Carolina, South Carolina, and Tennessee, where similar exemptions or repeals for ASCs have been implemented to promote competition.
This is especially important in underserved areas like our own Orange County, where residents have to drive, in some cases, an hour in each direction for simple procedures.
Independent ASCs deliver high-quality care at lower prices, exempting them from COPN could save Virginians millions annually, especially for common surgeries, while preventing hospital conglomerates from inflating bills. With healthcare costs rising, this targeted reform promotes efficiency, ensuring patient safety through existing licensing while addressing COPN’s failures in cost control.
The second piece of legislation I want to highlight that I will be fighting for is a change in authority of counties, cities, and towns to impose Business, Professional, and Occupational License (BPOL) taxes and fees. BPOL is a local tax on gross receipts from businesses, trades, professions, occupations, and callings, often criticized as a turnover tax that doesn’t account for expenses or profitability. The tax serves as a revenue source for localities, with rates varying by business classification and gross receipts thresholds. I am looking to exempt health professions from these taxes due to their unique business structure.
Consider a medical provider treating a cancer patient. The physician may charge $1,000 for professional services, while the prescribed medication costs $10,000. Although the provider earns little to no profit on the drug itself, the BPOL tax is applied to the full $11,000 in gross receipts. This approach effectively taxes pass-through costs as if they were income, creating a disproportionate tax burden for practices that administer high-cost medications.
We want you to be able to see savings in your everyday healthcare costs. I am committed to finding good solutions to everyday problems. If you would like to help me fight for these bills, please do not hesitate to call my office during session, or follow along on lis.virginia.gov. There, you can create an account with the Lobbyist-in-a-Box function, follow these bills, and be notified when they are in committee. You can then provide your own testimony in person or online.
I want, and need, our community’s support on common-ground legislation!
Local Obituaries
To view local obituaries or to send a note to family and loved ones, please visit the link that follows.
Support Award-winning, Locally Focused Journalism
The FXBG Advance cuts through the talking points to deliver both incisive and informative news about the issues, people, and organizations that daily affect your life. And we do it in a multi-partisan format that has no equal in this region. Over the past year, our reporting was:
First to break the story of Stafford Board of Supervisors dismissing a citizen library board member for “misconduct,” without informing the citizen or explaining what the person allegedly did wrong.
First to explain falling water levels in the Rappahannock Canal.
First to detail controversial traffic numbers submitted by Stafford staff on the Buc-ee’s project
Our media group also offers the most-extensive election coverage in the region and regular columnists like:
And our newsroom is led by the most-experienced and most-awarded journalists in the region — Adele Uphaus (Managing Editor and multiple VPA award-winner) and Martin Davis (Editor-in-Chief, 2022 Opinion Writer of the Year in Virginia and more than 25 years reporting from around the country and the world).
For just $8 a month, you can help support top-flight journalism that puts people over policies.
Your contributions 100% support our journalists.
Help us as we continue to grow!
This article is published under Creative Commons license CC BY-NC-ND. It can be distributed for noncommercial purposes and must include the following: “Published with permission by FXBG Advance.”