Usually, if you want to start a new business, you invest your time and resources and follow all the safety rules. But for some healthcare services, you must prove to the government that your business is needed by obtaining a “certificate of need”–which requires your competitors’ permission.
This would be harmful under any circumstances, but it’s especially dangerous when it comes to life-saving services.
In some states, entrepreneurs must get a certificate of need before they can open certain healthcare businesses, including birth centers, home health agencies, imaging facilities, nursing homes, and ambulances. Certificate of need laws have nothing to do with quality or safety. Instead, they’re about proving the “need” for your business—and they are designed to allow existing businesses to prevent competitors from entering the market.
Every presidential administration since Reagan has called for the repeal of certificate of need laws. Because not every state has these laws—about 40% of America lives in a state with zero or one certificate of need law—it’s easy to measure their effects on healthcare. Unsurprisingly, residents in states with certificate of need laws are stuck with lower quality care, have access to fewer facilities, pay more for care, and wait longer for care. The research overwhelmingly shows that certificate of need laws lead to bad outcomes for patients.
In courts and legislatures, Pacific Legal Foundation fights to liberate entrepreneurs and roll back Certificate of Need laws.
In April 2024, Governor Brian Kemp signed into law HB 1339, which reformed some of Georgia’s restrictions on healthcare innovation. The reform came several years into a legal challenge from Katie Chubb, a Georgia mother who was blocked from opening a birth center by the state’s certificate of need laws. The state even admitted that Katie’s services were needed in Augusta, but she couldn’t open because the local hospitals said no. Josh Polk, a PLF attorney who worked on Katie’s case, called HB 1339 “an empowering first step for expectant mothers and for healthcare freedom across Georgia.”
We’ve worked with Des Moines Midwife Collective in Iowa; Katie Chubb, a mother trying to open a birth center in Georgia; Ursula Newell-Davis, a social worker trying to provide respite services in Louisiana; and Phillip Truesdell, owner of an ambulance company, who successfully challenged Kentucky’s certificate of need law at the Sixth Circuit in 2023, establishing that out-of-state services cannot be required to obtain a certificate of need.
Our Birth Freedom Act model policy provides states with a solid legislative framework to preserve the longstanding right of women to choose and direct their maternal healthcare.
Check out our newest research report, Certificate of Need Reform: Answering the Fears.
Ursula Newell-Davis's story: A social worker fighting for change in Louisiana
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Liberating America’s healthcare services has never been more important. Support PLF’s efforts to throw out these absurd and unconstitutional laws for good.
