Healthcare Monopolies Are Hurting Our Parents and Grandparents

By Aaron Rice
June 15, 2021

My Father passed away from Alzheimer’s disease this past December. Alzheimer’s is a cruel disease and watching my Dad suffer from it was especially difficult for my entire family. 

Before entering a long-term care facility, my Dad received physical therapy in his home as his physical state declined. The visits did little to help, however. My Mother complained that the therapists were so overbooked that they could not schedule nearly as many visits as the doctor had requested. When they did visit, they rarely stayed for more than a few minutes.

My Mother didn’t know it at the time, but the home health agency that provided my Dad’s in-home physical therapy had little incentive to provide time-intensive, quality care. They had a monopoly on home health patients in the area they serviced. They would keep my Dad as a patient whether my Mother was happy with their services or not. 

Home health services enable the elderly to receive care in their homes rather than being institutionalized in nursing homes. And the role of home-based care is about to become more important than ever. 

The number of Americans over the age of 75 is expected to nearly double over the next twenty years, according to the U.S. Census Bureau. This aging population is expected to place massive burdens on our healthcare system, especially the long-term care industry. 

To address this looming crisis, President Biden has proposed spending an additional $400 billion in Medicaid funds on in-home long-term care services. Home-based care can be more cost-effective than nursing home care, and older Americans overwhelmingly prefer to receive care in their own home.

President Biden is right to look for solutions to the problems with long-term care. But a one-time cash infusion for Medicaid home health services would do nothing to change the real problems in the long-term care industry.

Thankfully, Mississippi does not have to wait for solutions from Washington D.C. There are steps we can take right now that would make a real difference in the quality, accessibility, and affordability of the care that our parents and grandparents receive. 

The most obvious reform would be to end the monopolies enjoyed by home health agencies like the one that treated my Father. Those monopolies are created by Mississippi’s certificate of need (CON) laws. 

CON laws push more seniors into nursing homes by limiting the availability of home health services. Certificate of need laws require anyone wanting to start a healthcare facility to first prove that there is an unmet need for those services in the community. Mississippi is one of only 14 states that impose CON requirements on home health agencies. 

Research shows that certificate of need laws serve to limit competition and prevent the expansion of the home health industry. A 2016 paper concluded that CON laws “act as a direct impediment of expansion of home- and community-based care” and “provide nursing homes with some degree of market power that does not allow the market to respond freely to price changes or federal policies.” Other research indicates that certificate of need requirements decrease the quality of care provided by home health agencies.

If our CON law wasn’t bad enough, Mississippi is also the only state in the nation that has imposed a complete ban on the opening of any new home health agencies in the state for the past 40 years. Instead, the state has chosen to allow existing home health agencies to have monopolies in their service areas. 

The Mississippi Justice Institute has filed a federal lawsuit seeking to end Mississippi’s 40-year ban on new home health agencies, as well as the state’s home health CON program. But state lawmakers should not wait for that litigation to conclude before taking the initiative to end these senseless policies.

Our parents and grandparents deserve a healthcare system that can adequately care for them. Monopolies that reduce the supply of care available to them, while driving up the price and decreasing the quality of their care should have no place in Mississippi.


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