What is a Certificate of Need?

In some industries, new businesses must apply for a license or “certificate” to prove that their service is “needed.” This is a long, tedious process that is unrelated to health and safety concerns.

Existing businesses that hold a certificate are invited to testify about whether they think new competition is desirable. That’s an obvious conflict of interest. And certificate holders enjoy a “competitor’s veto” power over new competition because the government often defers to their objections to new businesses.

“Competitor’s veto” laws limit the supply of services, mostly in the healthcare industry, including hospitals, birthing centers, home healthcare providers, MRI machines, nursing homes, and ambulances. These laws are also common in the transportation industry—over half of states require moving companies to obtain a Certificate of Need.

In courts and legislatures, Pacific Legal Foundation fights to liberate entrepreneurs and roll back Certificate of Need laws.


In courts and legislatures, Pacific Legal Foundation fights to liberate entrepreneurs and roll back Certificate of Need laws.

Thirty-nine states and the District of Columbia have CON laws for at least one medical service.


Competitor’s Veto: A Roadblock to New Businesses, a review of CON laws in the moving industry.

March 22, 2024

Economic opportunity matters, too

PLF fights against laws that keep entrepreneurs from providing their much-needed services. For example, we represent Katie Chubb in challenging Georgia’s certificate-of-need law, which prevents her …

September 14, 2023 | By LARRY SALZMAN

The Dispatch: The Supreme Court Can Fix Its Oldest Mistake This Year

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…

November 30, 2022 | By ERIC SHEAR

Choosing the Gatekeepers

One out of every four workers is not allowed to do their job without an official state-issued license. Licensing boards, using government power, control the marketplace for services in their industrie…

September 1, 2022 | By ANASTASIA BODEN

In a recent lawsuit, the Louisiana Department of Health admitted what every parent of a special needs child knows: There is always a need for more care for this population. Parents need time away from the rigors of child-rearing, whether it be to work, run errands, or simply have time to themselves.

One out of every four workers is not allowed to do their job without an official state-issued license. Licensing boards, using government power, control the marketplace for services in their industrie…

August 23, 2021 | By ANASTASIA BODEN

The Hill: Biden’s economic reform ought to consider certificate of need, too

President Biden recently called on the federal government to increase competition in the U.S. economy as a way of boosting wages, increasing employment, and allowing people to move between jobs. One o…

December 20, 2023 | By BRITTANY HUNTER

Pacific Legal Foundation's 2023 highlights

2023 was a particularly big year for Pacific Legal Foundation. We celebrated our 50th birthday, which gave us the opportunity to reflect on moments that made PLF what we are today. Since 1973, we have had the privilege of changing lives: We’ve helped our clients challenge unjust government actions in the court of law and …

December 19, 2023 | By BRITTANY HUNTER

When government gets between a mother and a midwife

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 …

October 11, 2023 | By BRITTANY HUNTER

Why won’t SCOTUS protect economic liberty?

The Supreme Court declined to hear a case that could have affirmed everyone’s right to economic liberty—an unfortunate decision that highlights a problem much larger than one case. New Orleans social worker Ursula Newell-Davis would like nothing more than to help families with special needs children. Raising an autistic son, along with 25 years …

September 20, 2023 | By BRITTANY HUNTER

USA Today: New Orleans social worker asks Supreme Court to protect freedom to work

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 …

September 07, 2023 | By JOSHUA POLK

Victory for Ohio family! Sixth Circuit rolls back certificate-of-need laws

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 licens …

July 11, 2023 | By BRITTANY HUNTER

South Carolina ends certificate of need laws in healthcare industry

Certificate of Need (CON) laws have long been a ball-and-chain around the ankle of South Carolina’s healthcare industry. But thanks to the passing of new legislation, these regulatory shackles have been removed and competition will soon return to the healthcare market across the state. CON laws are essentially permission slips that prevent new play …

September 01, 2022 | By NICOLE W.C. YEATMAN

Government blocks much-needed birth center in Georgia

A great test of any society is whether it takes good care of pregnant women and babies.   The State of Georgia is currently failing that test.  Georgia has the worst maternal mortality rate in the country—that is to say, more women die in childbirth in Georgia than in any other state.   The financial website …

May 19, 2022 | By BRITTANY HUNTER

Reforming CON laws is a matter of life and death

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, …

August 19, 2020 | By NATHANIEL HAMILTON

States that suspended Certificate of Need laws saved lives

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 …

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