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The state Senate passed legislation Thursday making significant reforms to Georgia’s Certificate of Need (CON) law governing hospital construction and medical services, over the objections of some Democrats who called for Medicaid expansion.

Senate supporters said the bill, which passed 43-11, represents middle ground between doing nothing to improve access to quality health care – especially in rural Georgia – and repealing the CON law entirely.

“We are trying to help rural health care in areas that are getting insufficient medical treatment,” said Sen. Bill Cowsert, R-Athens, chairman of the Senate Regulated Industries Committee. “We call them health-care deserts.”

The Georgia House of Representatives overwhelmingly passed the bill last month, sending it over to the Senate.

The measure would exempt proposals to build hospitals in rural counties from having to obtain a CON from the state Department of Community Health – often a cumbersome, multi-year process – if they plan to have a full-time emergency room, accept psychiatric and substance-abuse patients, participate in Medicaid, provide indigent care, and agree to feature a training component.

The bill also includes provisions aimed at helping specific hospital projects. A provision allowing rural hospitals that have been closed to reopen without a CON would allow the reopening of a closed hospital in Cuthbert, Cowsert said.

Another provision exempting a proposed hospital in southern Fulton County from having to get a CON would pave the way for a facility to replace the Atlanta Medical Center, which closed its doors in 2022. The new hospital would serve as a teaching facility for the Morehouse School of Medicine, Cowsert said.

The legislation also would exempt new obstetrics practices as well as birthing centers from the CON law and would raise the state’s rural hospital tax credit from an annual cap of $75 million to $100 million.

Some Democrats who supported the bill said they did so only as a first step toward expanding Georgia’s Medicaid program through the Affordable Care Act, as 40 other states have done.

“Without Medicaid expansion, we’re depriving a lot of these new facilities of customers and, quite frankly, of income,” said Sen. Harold Jones, D-Augusta.

“CON reform is needed,” added Sen. Jason Esteves, D-Atlanta, who voted against the bill Thursday. “[But] CON reform alone will not solve our health-care issues in Georgia.”

But Cowsert urged his Senate colleagues not to “let the perfect be the enemy of the good.” He said a state commission the bill would create to examine how Georgia can improve health-care access would include Medicaid expansion on its agenda.

The Senate amended the House version of the bill to guarantee Democrats two seats on the commission.

“It you want to make progress on health care in Georgia, this is the vehicle to do it,” Cowsert said.

The bill now moves back to the House to consider the changes made by the Senate. It could end up in a joint House-Senate conference committee to work out a final version of the legislation during the waning days of this year’s General Assembly session.