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To oversee or not to oversee?: lessons from the repeal of North Carolina's certificate of public advantage law
To oversee or not to oversee?: lessons from the repeal of North Carolina's certificate of public advantage law
In the fall of 2018, the Milbank Memorial Fund published a paper about Virginia and Tennessee's certificate of public advantage (COPA) law. Now, in a new issue brief, the same author writes about North Carolina's COPA, which was initiated to allow a health system to merge and create a monopoly. The law was enacted in 1993 and remained in effect until its repeal in 2015. (1) The terms of the approved COPA in North Carolina were considerably different from the recently approved COPA for Ballad Health in Tennessee and Virginia, with fewer resources for public oversight and population health efforts. (2) The COPA's subsequent repeal in North Carolina created a regulatory void in state oversight that allowed the merged hospital system to become an unregulated monopoly and then offer itself for sale to a national health system. (3) In considering policies to address provider consolidation, state officials must guard against the risk that COPAs will be used as a long-term strategy to gain an unregulated monopoly that creates the very disadvantages the state's COPA law was designed to prevent.
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