Georgia Lt. Gov. Burt Jones recently announced that new state senate study committees will examine whether and how to reform Certificate of Need (CON), occupational licensing, and state tax credits, including those for film. The Georgia Public Policy Foundation recently interviewed Jones about those topics as well as Educational Savings Accounts (ESAs). Senate Bill 233 would have created $6,500 Promise Scholarship Accounts for students who leave low-performing public schools for private or home schooling. The bill failed in the House on an 85 to 89 vote.
OCCUPATIONAL LICENSING
What are your long-term goals for occupational licensing?
We are just trying to get rid of duplicated services. We want to try to make it easier for people in different professions to come in from different states and get licensed here in the state of Georgia. Are the standards or requirements a little bit too rigorous for some industries to figure out? Are there ways to make it easier to access and get their license either reinstated or recognized as they come from a different state? I don’t think a dentist who has been practicing in South Carolina and decides to move to Georgia should take years to set up an operation or perform services here in Georgia.
In the field of cosmetology, there was an attempt this year to do away with occupational licensing requirements. There was pushback from people who said those requirements are needed to protect health, public safety, etc. From what I have gathered, a lot of state legislators agree with that.
Number 1, you must educate and inform the public and interested parties on what good practices are going on. Some are redundant or negative or have a negative impact on the public or the individuals as well. We will vet that, and the ones that make sense we will try to move on those. For the ones that could create more of a problem than a solution then we will probably leave those alone.
TAX CREDITS
Can you talk about the committee looking at the tax credits?
We have enjoyed a good business climate in Georgia for the last decade, and a lot of it has been fueled by the tax credits and incentives that we have been doling out at the state level. I have always been a big believer in trying to model our state after Florida, Tennessee and Texas and getting rid of our state income tax or at least significantly reducing it.
I think the only way you can do that is by looking at the tax credits and incentives that you have been giving out, which isn’t the billions of dollars, but it is a lot of different industries. There are some industries that are more visible than others, but our goal is to get rid of the ones that are not beneficial from a jobs standard or producing jobs or from a real economic impact. They are based on who was able to hire the best lobbyists. Get rid of those first, and then reassess the other ones. We will be methodical about it. We won’t shoot off the hip. We will be mindful of which ones are beneficial and which ones are not and which ones might need tweaking a little bit. Some might need to be completely gotten rid of.
Do you have thoughts about what needs to happen and what results you are looking for?
My main objective is to look at ways to lower our state income tax. I’d like to get us to a point where we eliminate it. I know that will be a tall order. I think that finding ways to continue to lower it is essential. That is the No. 1 goal. And No. 2 is we will look at the low-hanging fruit.
There are a lot of tax credits and incentives that have been doled out over the last decade that probably don’t have the economic impact from a jobs’ creation standpoint, and so we will look to get rid of those.
There are some big ones that probably need to be either capped or have them put a sunset on at some point. There are several things we want to do. I want to be mindful and not do anything like what Louisiana did where one year they had the movie tax credits and then the next year they were gone and, guess what, the whole industry left.
We do want to assess and make sure the state of Georgia is benefiting more from the tax credits than the individual companies taking advantage so far.
EDUCATION SAVINGS ACCOUNTS (ESA’s)
As it pertains to ESA’s, what are your goals?
I come from an area where we have some really good public schools. My mother was a public educator.
I was fortunate enough to have options growing up and to give my children options. School choice is becoming very popular across the country. I also think SB 233 is a good first step for us. We got it out of the Senate, and that is the first time I have seen it moved out of the Senate since I have been around. It stalled in the House, but I feel good about our chances of getting it across the finish line next year.
I have two kids, a 14-year-old and a soon to be 11-year-old. I have had more parents come up to me at my daughter’s soccer game wanting to know if that bill had passed because they wanted to take advantage of it for their children. That is not common — to go to a soccer game and have the parents come up and ask you about legislation going on at the capitol.
I think state dollars should follow the children.
Parents ought to be given an opportunity to find the best school system structure for their kids. That is essentially what it boils down to. If we are really in it for the children and looking for the best opportunities for parents and kids, then we need to be doing things like school vouchers and school choice options that give parents that ability.
The ESA bill was narrowed during the committee process in the Senate. Does the narrowing need to stop there, or would you like to see it broadened out?
I personally would like to see it broadened, but I think 233 is a good first step. I think you can see some benefits from it. Once you can see the benefits, I think you will have a bigger following and a bigger push of people wanting to expand it further.
You say you want to see it broadened. Do you have anything specific in mind?
I would like the school vouchers. I would like the dollars to follow the student, but in the legislative process you must pass what you can pass. I think 233 was a good first step. It obviously pinpoints kids who are in failing school districts, and it’s important that parents have that option in those areas of the state where those are happening. If they are successful, which I think they will be, then you look at how you can broaden it more.
CERTIFICATE OF NEED
What is the big picture outcome you are aiming for as it pertains to Certificate of Need (CON)?
Number one, I think the CON process is kind of archaic in Georgia. I think it’s way outdated, and it needs reforming. When I was in the state senate, I watched the CON process hinder a couple of counties that I represented then, one being Morgan and another being Greene County.
There were similar situations. In Morgan County, they had an old facility they wanted to upgrade to a newer model. They even put it on a referendum for the locals to vote on. It passed. The locals even voted themselves a tax increase to build a new hospital facility, and, because of the CON process, from the time it was passed on a referendum to the time they broke ground on a new facility, it took more than four and a half years.
There was a similar situation in Greene County, where they had an old facility that they wanted to upgrade to a newer facility. St. Mary’s was the participant there. It was the same thing. It took five years because of the CON process from the time they started and until the time they started talking about wanting a facility.
Then they were able to break ground on one.
You have heard about various counties around the state. My county is one (Butts). But also Lee County, where the people down there have been pushing for a new facility. They are stuck in the CON legal battle going on three years now. And that is just talking about the rural communities. I won’t even talk about here in the Metro area where every time someone like Emory University and [Piedmont] Health systems must apply for a CON to get new radiation or X-Ray machines, etc.
I think it is past time when you talk about the needs of healthcare being so great and the demand being so heavy here in the state when we have bureaucratic red tape that prevents different operators or different medical suppliers from providing services. I don’t think it’s right. I think it needs reform, and that is why we have taken it on for the first year of me being in office. It is something I think is important to take on.
A hospital lobbyist told Georgia Public Policy that free market principles don’t apply to hospitals. He said two hospitals in the same town that offer the same service creates a competitive situation that hurts quality care. He used the analogy that “You would not want an open-heart surgery center in a given hospital and then have Lee County open another hospital that offers the same thing. It would take away from both hospitals.” He cites studies that show the more efficient you become the safer it is for the patient. Do you have a rebuttal?
I think it’s a ridiculous argument, quite frankly. Our bill would allow a lot of rural communities to control their own fate as far as health care is concerned. To be honest, rural communities are what we consider 50,000 people or less. About 120 counties fit that description here in Georgia.
The fact of the matter is No. 1, in a county that has 30,000 folks you aren’t going to have two hospital facilities. Because you won’t have the rooftops to support it. But if a county doesn’t have a facility and wants to have one, they ought to be allowed to do it, especially if the county commissioners or the local hospital authority are on board, or even the citizens, as was the case with Morgan County.
Right now, Lee County is a great example. It is in a fight right now trying to get a hospital that the community wants. The county commissioners voted unanimously for it, but they are being held up by folks in Dougherty County, in Albany, Georgia. I don’t think that communities that aren’t in the same jurisdiction ought to be able to dictate [to others].
Folks get paid to defend the CON system. You won’t get an answer that wouldn’t fit their dialogue on the system. But if you go to any community and you ask the question to rank and file citizens, would you like better healthcare in your community and if you could have it would you hate for the state of Georgia to stand in the way? Everyone said “Yeah, we would.”
I think the CON is an outdated system put in place to protect those already in that business and keep out new people from entering into it. Nobody likes a monopoly unless you benefit from it. The gentleman you just talked about is benefitting from a monopoly, quite frankly.
Advocates of CON say it’s needed because the government is the largest payer into the hospital system on behalf of patients, and that makes CON necessary for that reason.
I have heard everything, but I don’t pay attention to what they say because they are not looking at it from a neutral position. They are paid to protect that CON system. They are not objective, but when I have different communities come to me wanting to build and set up shop, whether it be a hospital facility or some sort of medical specialty care, whatever it might be, they complain about a regulatory item that has been put in place by state law.
I think there is a real need to eliminate those burdens and let them take on the risk because that is what they will be doing themselves. It will work its way out one way or the other. Either they will be right or wrong with the decisions they want to make in their local communities.
The CON proponents say the Georgia Department of Community Health (DCH) rejects very few hospital proposals, but they say approval rates are as high as 97 percent, thus making attempts to do away with CON unnecessary.
I do know that. Even when we passed this bill, there are a lot of counties that probably will not take advantage of it, because in the final analysis, to make a hospital work, you must have done all of your leg work on the front end. You must have feasibility studies. If you are making a business decision on this, you must have things to illustrate that it can be successful.
Out of that, about 112 counties fit into the rural counties’ perspective.
Probably a dozen or so, not a high percentage, would still have the means or the gumption to do it, but that still doesn’t change the fact that you ought to give them the opportunity to do it if they want to. I don’t know what the percentage of approved facilities have gone through the DCH, but what I have seen is something that does nothing but be an unnecessary obstacle for those communities that do want to try to do it.
Big-monied interests oppose you on CON. What is the best strategy to overcome that?
You just chip away at it. You start with what we have with SB 99. Once you start down that road and see that the pillars of the health care committee aren’t going to crumble because a couple of new rural hospitals were able to get off the ground, you’ll see that it’s not the boogeyman behind the door that the proponents of it want to make you believe that it is.
One could say that CON is not a sexy enough topic. It may not lead headline news or get discussed on the news, if ever. It may not be something that people sit around and discuss and debate at coffee shops. But if more members of the public were aware of this issue could the tide turn in your favor?
No question. When you talk to the average everyday citizen, especially ones who live in communities where they don’t have good access, if you ask them what you would think if a state regulation was preventing your community from having access to critical health care specialists, they would be appalled by it. But that is part of why we will do this study committee, to help educate people and help get people informed and make them aware that a lot of times in particular these communities that don’t have access to anything are held up by a government regulatory outdated system.
The Atlanta Journal-Constitution (AJC) published an article that said you and your family have a conflict of interest with you pushing CON. Allowing the construction of hospitals could benefit your father’s business.
My father’s business is in gasoline. That is his main business. There is no question we have been big advocates for health care in our communities. We don’t have good access. When we don’t have something serious, we must drive to Atlanta or Macon to get good access, 60 miles one way or the other. We’ve got the local board of county commissioners in full support of us getting a hospital. The AJC said it could end up on some of my father’s property. That is the key word right there — COULD.
But there is no designated property that has been picked out, but there is an effort of wanting to get a good quality regional hospital there in our county.
That was a hit piece from people who profit off protecting the CON policy, and that was them trying to throw shade on something we were trying to do to benefit a lot of counties like ours.