Millions of Americans are awaiting the COVID-19 vaccine.  But making sure the vaccine is delivered efficiently and safely is a challenge in itself.  The supply chain requires quick adaptation and decision-making, as both the Pfizer and Moderna vaccines must be stored at extremely cold temperatures to remain effective. 

This unique requirement is causing hospitals across the country to purchase special refrigerators to store the vaccine.  Rural hospitals typically can't afford ultra-cold freezers to store the vaccine.  These freezers can cost anywhere from $10,000 to 20,000.  For hospitals in underserved communities that are operating on slim margins, this is a problem.

During nonpandemic times, vaccination rates in rural communities are much lower than in metropolitan areas.  Rural counties have the lowest flu vaccination rates.  As a rural county family physician and the Wilson County health officer in Fredonia, Kansas, Dr. Jennifer Bacani McKenney, explains, "we don't have the convenience of jumping into a Walgreens, CVS, or Walmart and getting our flu shot.  Our nearest Walgreens and Walmart are 30 miles away.  Because of financial, storage, and staffing issues, none of the providers in our county and many private providers across the state do not provide in-clinic vaccinations, so the patient is required to make an additional appointment to get vaccines at a health department."

One inhibiting factor limiting access to these vaccines is the overreaching Certificate of Need (CON) laws on the books.  Currently, 35 states are bound by CON laws, which  have negatively impacted the medical marketplace.  The intent is good, but the outcome is higher costs, less access, and less innovation.

CON requires the state or executive board to determine need in any hospital expansion, including aspects like number of beds and storage freezers.  According to research by the Mercatus Center, states operating with CON laws have fewer rural hospitals and ambulatory surgical centers.  States with CON laws are also less adaptable.  As we have seen in 2021, adaptation in the medical marketplace is of utmost importance.

These laws also undermine patient choice and put the interests of large hospitals over individual patients.  CON laws are inherently anticompetitive, and repealing or reforming CON within rural areas would increase competition in underserved communities.  As we know, competition results in better products and services at a lower cost for consumers.

The United States continues to lead the world in health care innovation.  Yet states operating with unnecessary CON laws limit health care expansion.  These antiquated laws lack transparency and political accountability.  Legislators should aim to reduce health care costs, increase access, and improve quality.  CON laws negatively affect all these goals.

If anything, 2021 offers a great opportunity to repeal these outdated policies.  If a full repeal is not a viable solution, reforming current CON statutes to decrease the scope in which these laws impact the industry is at least a good first step.

Christina Herrin (cherrin@heartland.org) is the government relations manager at The Heartland Institute, a nonpartisan, free-market think-tank headquartered in Arlington Heights, Ill.

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