Iowa reform allows for new options for healthcare, expanding access and lowering costs

Des Moines, Iowa; May 14, 2026: Yesterday, Iowa Gov. Kim Reynolds signed legislation scaling back the State’s certificate of need (CON) laws, which require healthcare providers to receive a permission slip from their competitors before opening or expanding facilities. House File 2635 raises the cost thresholds that trigger CON review and narrows the categories of projects subject to review.

“Certificate of need laws don’t protect patients; they protect incumbent providers from competition,” said Kileen Lindgren, State Policy Manager with Pacific Legal Foundation. “When the government decides who gets to open a hospital or clinic, it’s consumers who pay the price, in higher costs and fewer choices. Iowa’s reform is a win for every patient who deserves access to affordable, quality care.”

Iowa’s CON law has long required healthcare providers to prove to the State’s satisfaction that their services are needed — including demonstrating that existing facilities operate “efficiently” — before opening or expanding. HF 2635 eliminates the ambiguous efficiency requirement, removes payers from the review process, raises CON thresholds to $4 million, and exempts several categories of projects entirely — thereby increasing accessibility and lowering costs for Iowa residents.

Pacific Legal Foundation is proud to have partnered with Americans for Prosperity – Iowa, Iowans for Tax Relief, and Iowa Independent Physician Group in advocating for this reform.

PLF is fighting certificate of need laws in courts and legislatures across the country. Iowa’s reform joins a growing national movement to restore competition and lower barriers to healthcare access.