DES MOINES — Iowa hospitals and clinic operators were at odds in their reaction to a proposed bill to change the state’s approval process for new hospitals that lawmakers advanced on Wednesday.

Most new hospitals and clinics in Iowa must receive a certificate of need from the state’s Health Facilities Council in order to begin construction. The process weighs the demand for services in the area and input from consumers and other health facilities in the region.

Under Senate File 506, the Health Facilities Council would be dissolved, and authority over certificates of need would go to the Iowa Department of Health and Human Services.

Under the bill, new outpatient facilities, community mental health facilities and birth centers would be able to open without receiving a certificate of need.

Changes to a health facility’s services that cost less than $3.5 million would not be subject to a Certificate of Need, and that threshold would increase incrementally to $5 million in 2038.

The bill also would remove the requirement for facilities to receive a certificate of need for a range of other service changes.

Representatives from community hospitals around Iowa were at the Capitol on Wednesday to oppose the bill, saying that changing the certificate of need process would hurt hospitals.

Hospitals are required to offer a range of services regardless of whether they are profitable and provide care to people regardless of their ability to pay, administrators said. The more profitable services often subsidize the less profitable.

Steve Slessor, the chief administrative officer at Winneshiek Medical Center in Decorah, said allowing clinics to open without receiving a certificate of need could cause hospitals to close.

“If other entities are allowed to come in and open up where there’s not a need … then what happens?” he said. “For-profit, profitable business lines get pulled out, non-profitable business lines stay within the hospitals, and I think we can all do the math and understand what happens under that circumstance.”

But independent physician groups and clinic operators said the certificate of need process is burdensome, too restrictive and in need of reform. Some proponents of the bill said the certification process leads to less competition and fewer health care options.

Lawmakers said they were open to working with providers to find a compromise and update the state’s certificate of need process. The bill, which passed in the Senate last year, advanced out of a House subcommittee on Wednesday.

“I see the need for protection for our rural hospitals, but I also see the need for modernization and workforce being an issue, access to care being an issue,” said Rep. Thomas Moore, R-Griswold. “I would like to see us continue to work this.”

Topsoil bill dies in House floor debate

A bill that would have loosened topsoil and stormwater regulations at construction sites failed to pass a vote by the Iowa House during floor debate.

It is rare for legislation to be voted down on the floor of the Iowa House or Senate. Usually, legislative leaders only plan to debate a bill once they know they have enough votes to pass it.

The bill would have prohibited counties and cities from adopting regulations stricter than what the state permits for topsoil management at construction sites. It also would have restricted the regulations local jurisdictions can place on the stormwater infrastructure required for new developments.

During floor debate, proponents said the bill was designed to make housing more affordable for developers and homeowners. Opponents said it would infringe upon local governments’ ability to regulate stormwater.

The bill, Senate File 455, then failed on a 49-44 vote, with 16 Republicans joining all Democrats in voting against it. Seven House members were absent or did not vote.

That makes the bill technically ineligible for further consideration this year, although legislative leaders have options to resurrect such bills.

Gadsden flag license plates

Iowans would be able to purchase a license plate featuring the yellow “don’t tread on me” Gadsden flag, with revenue from increased fees going to fund training and education by National Rifle Association-affiliated groups, under legislation that passed out of the Iowa House.

Democrats, who opposed the bill because of the funding to NRA groups, introduced 29 amendments to propose other types of specialized license plates with resulting revenue going to their pet issues, like women’s reproductive health care, public education, cancer awareness, and union support. Democrats withdrew those amendments before asking for a vote on each.

“The reason we’re running them is because there are problems in this state, there are issues we are facing, and we are spending our time on a license plate to fund the NRA,” said Rep. Jennifer Konfrst, D-Windsor Heights, the House Minority Leader.

Rep. Jeff Shipley, R-Birmingham, said the license plates would celebrate Iowans’ support for gun owner rights and the Second Amendment to the U.S. Constitution.

The bill, House File 2639, passed the House on a largely party-line vote, 60-34, with mostly Republicans supporting and Democrats opposing. It is now eligible for consideration in the Senate.

Megasites bill passes House

A $93 million tax incentive program designed to lure economic development projects to so-called mega sites — projects that span at least 250 acres with investments of at least $1 billion — passed the Iowa House with strong bipartisan support.

Senate File 574 passed the House, 90-4. Because it was amended during House debate, the bill must go back for final approval in the Senate before moving to Gov. Kim Reynolds for her consideration.

The proposal was introduced by the Iowa Economic Development Authority, the state’s economic development agency. Under the bill, a qualifying investment tax credit, a sales tax refund and a withholding tax credit would be available to qualifying projects.

Meat substitute labeling requirements

Meat substitute products whose label does not include a disclaimer noting the product is not real meat could not be sold in Iowa under legislation that advanced in the House.

Under the bill, the labeling requirement would apply to manufacturers and would not place any requirement on grocers, and manufacturers of meat substitute products would be allowed to use meat-related terms like burger, sausage, patty or link — as long as the package makes clear it is a plant-based or lab-grown product.

Proponents of the bill say it is needed to better help consumers understand what kind of product they are buying, and to protect Iowa’s livestock farmers.

The bill also prohibits Iowa’s public schools, regents universities and community colleges from purchasing lab-grown products and would require the state to apply for a waiver to opt out if the federal government ever approves a lab-grown meat substitute for purchase under federal nutrition assistance programs like SNAP for individuals and families or WIC for expectant mothers.

The bill, Senate File 2391, previously passed the Iowa Senate unanimously. In its first step on the House side, Republican Reps. Heather Hora and Mike Sexton signed off on advancing it out of a subcommittee. The bill is now eligible for consideration by the House Agriculture Committee.