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.
Ursula Newell-Davis's story: A social worker fighting for change in Louisiana
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Certificate of need laws were supposed to ensure high-quality health care in rural places. Instead, they allowed hospitals to veto potential competitors.
It’s been my pleasure to get to know Katie Chubb and learn more about her struggle to obtain a Certificate Of Need (CON) for her proposed birth center in Augusta. She is a passionate advocate for wo…
The service Emily Zambrano-Andrews and Caitlin Hainley offer looks very different from what happens in a hospital maternity ward.
Too often, it’s government bureaucrats acting under the influence of special interests and against the wishes of doctors and patients, with sometimes tragic results.
This article first appeared in the winter 2023 edition of Sword&Scales. The birth of a child is a sacred experience in a mother’s life. How and where she chooses to bring her baby into the world is a deeply personal decision that should be free from government interference. Yet in some states, certificate-of-need (CON) laws […]
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Pacific Legal Foundation recently petitioned the Supreme Court the case of New Orleans social worker Ursula Newell-Davis, who argues that Louisiana’s certificate-of-need laws violate the right to earn a living. Writing for USA Today, former Pacific Legal Foundation attorney Anastasia Boden, who is still working with PLF on this case, explains the situation: A social worker […]
The Sixth Circuit Court of Appeals just delivered a blow to economic protectionism in a case Pacific Legal Foundation has been litigating for four years. Phillip Truesdell and his children run Legacy Medical Transport, a small, non-emergency ambulance service in Aberdeen, Ohio, a stone’s throw from the Kentucky border. The company is fully licensed in […]
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The South Carolina House Ways & Means Committee failed to move forward on a bill that would have abolished the state’s antiquated Certificate of Need (CON) laws, which give existing businesses a competitor’s veto to block new businesses. In January, the bill passed the Senate with overwhelming support (35-6 vote) from both political parties, […]
During the global pandemic, healthcare providers have expanded their ability to care for additional patients by adding beds and ventilators and expanding facilities. But laws in some states prevent providers from taking steps needed to expand care options. Now we have a clear accounting of the costs of these laws: A new working paper by […]
Liberating America’s healthcare services has never been more important. Support PLF’s efforts to throw out these absurd and unconstitutional laws for good.
