ATLANTA (AP) — A Georgia Senate committee recommended on Tuesday that the state abolish its requirements for permits to build health facilities, setting up a renewed push on the issue after a debate in the 2023 legislative session mushroomed into a House-Senate standoff.

The conclusion was little surprise after Republican Lt. Gov Burt Jones appointed many committee members who wanted a full or partial repeal of Georgia’s certificate of need rules.

“What we heard pretty consistently in our work around the state was that access to health care is being constricted by these existing laws,” state Sen. Greg Dolezal, a Cumming Republican and Jones ally, said after the special committee adopted its final report on a 6-2 vote.

What happens in 2024 will depend most on what the state House is willing to do. A parallel House committee studying the issue has yet to submit a final report. The committee heard testimony last week on expanding Medicaid, suggesting some lawmakers might be willing to abolish the permits in exchange for extending health care coverage to many poorer Georgia adults who currently lack it. North Carolina lawmakers agreed to a deal to expand Medicaid in exchange for loosening permitting rules, which was discussed in the House meeting.

“They broached the topic, which we did not broach in our in our meetings,” Dolezal said of expanding Medicaid. “It’s something that I’m not sure that there’s an appetite for in the Senate, coupling those two things together.”

Gov. Brian Kemp launched a narrower Medicaid expansion for low-income adults, requiring them to document 80 hours a month of work, volunteer activity, study or vocational rehabilitation. Fewer than 2,000 people had enrolled as of early October, raising questions about the effort’s viability.

Certificates of need, in place in Georgia since the 1970s, require someone who wants to build a new health facility or offer new services to prove an expansion is needed. The permits are meant to prevent overspending that would increase health care costs.

Incumbent hospitals and health care providers often oppose new developments. Those who dislike the certificates say the law has outlived its usefulness because the government and insurers now seek to control costs by negotiating prices in advance. Instead, they say certificates prevent needed competition and prop up existing health care facilities’ revenues.

While some states have repealed certificate-of-need laws, Georgia is among 34 states and the District of Columbia still using them.

The Georgia Hospital Association, a longtime defender of the law, made some suggestions to loosen the rules. The association said the state should still require permits for outpatient surgery centers, so other providers don’t skim off a hospital’s most profitable procedures and weaken its overall financial standing.

The Senate committee adopted recommendations for changes to the rules if lawmakers stop short of a full repeal. Among those are loosening the rules on surgery centers, dropping permit requirements for anything related to childbirth and newborn care, and letting new hospitals be built anywhere without certificates starting in 2025.

Much of this year’s debate was centered on a Senate bill that would have ended permits for hospitals in counties with fewer than 50,000 residents. That measure was aimed at allowing a new hospital in Butts County, the lieutenant governor’s home.

There, Marietta-based Wellstar Health System operates the county-owned Sylvan Grove Hospital. County commissioners say the 25-bed hospital doesn’t provide enough services.

Wellstar has said a new 100-bed hospital would hurt both Sylvan Grove and its hospital in nearby Griffin.

The Atlanta Journal-Constitution reported a new hospital could be built on land that Bill Jones, Burt Jones’ father, has purchased.