A clash of ideology was on display last week in the Mississippi Legislature.

On one side were free-market conservatives who want to overturn the state’s longtime system of limiting new medical facilities and services. On the other side are defenders of the current system who fear that changes could harm financially fragile parts of the state’s current health care system.

The debate is over what are called certificates of need. Now, if someone wants to build a new hospital, buy an expensive piece of equipment, or offer a new medical service, they have to get approval from the state Health Department.

It was once a federal requirement that all states use such a system, aiming to create a statewide plan for a health system and cut costs by reducing duplication. But the federal government repealed its mandate in 1987, and since then 14 states have repealed their laws, according to the National Conference of State Legislatures .

Mississippi has not ended its system, despite conservative criticisms that the licensing system gets abused by existing providers seeking to prevent competition and has not reduced costs.

Some Republicans are trying to change that, though. House Medicaid Chairman Chris Brown last week sought to move House Bill 1174 to the full House. It would have removed major parts of the certificate system, no longer requiring approval before spending more than $1.5 million on medical equipment or before adding services such as heart surgery or cancer radiation treatments. It also would have removed the requirement that new outpatient surgery centers or kidney dialysis facilities get a state license.

The bill would have left the licensing requirement in place for other facilities, including hospitals and nursing homes.

“We think it will add competition into this market,” Brown said. “We think it will increase access to health care and bring down the cost like it has in other states where they have a less restrictive process.”

The measure would also stop tracking ownership of some facilities and no longer require state approval for a facility to be sold.

Brown asserted that the change would increase service in underserved areas, but many members of the committee scoffed at that idea. State Rep. Steve Holland, a longtime Plantersville Democrat who led Medicaid oversight when Democrats were in power, suggested that people would seek to provide more services in relatively affluent urban areas, but not in poor or rural areas.

“I think you’re riding on a philosophy of freedom, which sounds good,” Holland said. “Freedom does not always equal access to health care in Mississippi.”

Holland also suggested that Mississippi, with a poor and rural population, might not be suited to plans that have been tried elsewhere.

“Health care and markets don’t fit the typical definition of markets and free enterprise,” he said.

Outpatient surgery centers have been a particular sore point. When first created, they threatened hospital revenue by providing a cheaper location for surgery that doesn’t require an overnight stay. In some places, hospitals now own the surgery centers, though, and Brown said he hoped his bill would encourage more physicians to compete with hospitals.

Lawmakers already have tried to expedite the certificate of need process, with a law that took effect in 2016 mandating time limits on how long health officials could take to review and rule on an application.

Not surprisingly, though, there’s a clash on whether those changes have gone far enough.

“It takes too long to get the certificate,” Brown said. “It’s too expensive to get the certificate.”

Holland, though, saw it differently.

“It’s a lot better now than it’s ever been in history,” he said.

Jeff Amy has covered politics and government for The Associated Press in Mississippi since 2011. Follow him on Twitter at jeffamy.