The state's hospitals would not have to get public approval for the construction of new facilities under a bill that lawmakers quietly passed during the final hours of this year's legislative session.
The requirement eliminated under the measure applies to the state's 82 small, rural hospitals, including those in this region. In the past, they have had to submit to public hearings and obtain a "certificiate of need" from the state before relocating to newly constructed replacement hospitals.
Rep. Clarence Hoffman, R-Denison, was a key supporter of the bill. In his hometown, a public debate has raged over a proposal to build a new Crawford County Memorial Hospital.
Hoffman admits in a copyright story in the Des Moines Sunday Register that lawmakers kept the bill quiet. He said that was to help ensure passage of the measure.
"Because of the controversy going on in Denison - and that's due to a very small number of people - we were kind of hoping that this would stay quiet, stay low-profile," he told the newspaper.
He added that the bill, which is still subject to a veto by Gov. Chet Culver, could be threatened by public attention.
"I'm really sorry this has surfaced," Hoffman said. "Your article could cost us one heck of a lot of money. If that happens, I won't be very happy."
He explained that if Culver vetoes the bill, the Denison hospital and others like it will have to pay tens of thousands of dollars to justify plans to replace their buildings with new facilities.
Hospitals must currently demonstrate to the state that their proposed projects are the most cost-efficient means of addressing unmet patient needs in order to obtain the "certificate of need." The state's process was designed to block unnecessary construction of new hospitals, including ones being built to simply increase market share.
Hoffman's bill appeared to be dead twice this session, but it was resurrected and passed as a amendment. Rep. Jo Oldson, a Des Moines Democrat and chairwoman of the Senate Appropriations Committee, sponsored the amendment.
Another Democrat, Sen. Jack Hatch, of Des Moines, said he was discouraged by the way the bill was handled.
"It's really a very undemocratic thing that happened here," he said.
Iowa Department of Public Health officials say the new legislation would enable Iowa's 82 critical-access hospitals to bypass the certificate-of-need process.
"One of the biggest contributors to the growth in health care costs is the rapid expansion of these facilities," Hatch said. "This legislation allows 80 or so Iowa hospitals to replace their hospital without any citizen input and without any justification of the cost. It's just another reason why our health care costs are going up."
But Hoffman said hospitals shouldn't be forced to make their case to the state.
"You know, small towns are small enough that their hospital boards have to account to the people in town, and so they don't do things unless they are the right thing to do," he said.