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
Despite decades of evidence that CON laws suppress supply and raise costs, they remain relatively widespread throughout the country.
In acknowledging the struggles faced by rural hospitals, Congress recently created the Rural Healthcare Transformation Program. The program aims to increase access to health care in the areas that nee…
Officials at the Centers for Medicare and Medicaid Services (CMS) have said they would seek to support changes at the state level to strengthen competition, including addressing uncompetitive certific…
A new rule from the federal Consumer Financial Protection Bureau (CFPB), slated to take effect in March, will remove health care debts from credit reports and bar lenders from considering medical debt…
State regulators have approved an additional 70 hospital beds and four operating rooms for hospitals in Wake County, a far cry from the 246 hospital beds and 13 additional operating rooms that were re…
In a recent column, state Delegate Scot Heckert argues that West Virginia’s Certificate of Need (CON) program is needed to protect health care services in rural communities.
Ursula Newell-Davis has been a social worker in New Orleans for more than 20 years with a particular passion for special needs children (including her own), so she knows special needs families are oft…
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…
Welcome to the first CON Quarterly in 2026— Happy New Year, Readers. As a reminder, in markets where the government requires a certificate of need or CON, those who wish to offer a new service o…
Montana Supreme Court revives entrepreneur’s challenge to licensing laws that let big companies block competition and the right to earn a living.
According to the Maine Bureau of Insurance, Mainers can expect to see increases of as much as 25% in health insurance rates beginning in 2026. While Maine already has some of the highest health insu…
Modern discussions of inequality focus on wealth gaps and wage stagnation, but “time inequality” is less visible, harder to measure, and arguably more corrosive than income inequality.
Welcome to the Second Edition of the CON Quarterly. As a reminder, in markets where the government requires a certificate of need or CON, those who wish to offer a new service or expand an existing se…
One of the most personal healthcare decisions a woman can make is how she brings her babies into the world. Whether she chooses to deliver in a hospital with a doctor, or with a midwife in a birth cen…
Access to healthcare is a nationwide problem. Lack of access might be attributed to too few facilities, too few providers, or unaffordable prices. States are finally waking up and acknowledging that d…
Emergency rooms across the country are overcrowded, forcing patients suffering from severe illnesses to wait hours for treatment. Worse, when there are sudden increases in illness—say from an influe…
Nebraska’s healthcare industry is handcuffed by certificate of need (CON) laws, and state senators hold the key. CON laws limit healthcare access, prevent growth in the industry, and raise prices. T…
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…
Liberating America’s healthcare services has never been more important. Support PLF’s efforts to throw out these absurd and unconstitutional laws for good.
