America
States Seek End to Curbs on Medical Competition
Known as certificate of need laws — or CON jobs — they push up prices and reduce consumer choice.
A BY ALICE GIORDANO
bipartisan movement aims to overturn laws blamed for high healthcare costs, a lack of treatment
choices, and even medical errors. The certificate of need (CON) laws
allow healthcare providers to block competitors moving into their market simply by arguing they’re not needed. The government can then deny
a “certificate of need” — a manda- tory permission slip to do business in a state. It is why they are often referred to as
veto laws or CON jobs, explained Gold- water Institute’s Timothy Sandefur, a national legal expert on CON laws who wrote about the legislation in his book The Permission Society.
hospital told her the next available appointment was in four-and-a-half months. She later learned the hospital had
used West Virginia’s CON laws to block a new birthing center from opening. In Asheville, North Carolina, the
only hospital in a 50-mile radius used CON laws to block the construc- tion of a medical facility in adjacent Madison County, despite a 2025 state report that North Carolina is short 222 hospital beds. Former Black Hawk County Sheriff
Tony Thompson said that after Iowa’s CON laws were used to block the con- struction of a psychiatric facility in the area, the county jail was overrun with inmates who belonged in a treatment facility, not a jail cell.
Originally, CON
laws were designed in the 1880s to pro- tect the railroad industry and util- ity companies from competition. In 1974, Con-
gress enacted a federal CON law specifically aimed at the healthcare industry to pre- vent what lobbyists called “wasteful”
Some say they are more like mafia
tactics. And while no one is being threatened with cement shoes, CON laws have sunk competition. Shortly after moving to West Vir-
ginia, Brittney Paul, pregnant with her third child, soon found herself driving 40 minutes across state lines to get prenatal care after her local
32 NEWSMAX | MAY 2026
duplicate services. That was hardly the outcome. A recent study published in the
Health Education Journal found that hospital costs in states with strict CON laws are at least 20% higher than in states without CON restrictions. Last April in Connecticut, accord- ing to a report by Radiology Busi-
ness, a diagnostic imaging center had to put its plans to buy a new MRI machine on hold after a competing radiology facility contested its certifi- cate of need application. While the federal CON law was
repealed years ago, most states kept them, with many even expanding them, such as Massachusetts — where CON laws apply to more than 37 types of businesses, including pharmacists. Unsurprisingly, Massachusetts has
some of the highest healthcare costs in the nation. So far, the Supreme Court has
rejected numerous requests to weigh in on the controversy, although that could change. Four different federal appellate
courts have reached conflicting con- clusions about the constitutional standing of CON laws. That has cre- ated what’s called a circuit split, which often triggers a Supreme Court review. Mississippi lawmakers have decid-
ed not to wait around for the courts to sort it out and have joined other states in spearheading legislation to repeal the state’s CON law. More than a dozen states have
pending bills to end CON laws, including Nebraska. There is also pending legislation in
Maine, where doctors have said that they want competition. One of them, Dr. Lisa Lucas, who
runs a family practice in Freeport, wrote in a letter that CON laws are allowing existing hospitals to block competition in rural areas while cut- ting back on the very services new- comers would bring. “We are witnessing hospitals close
essential but lower-margin services such as obstetrics and pediatrics, while simultaneously expanding high- revenue cardiac and orthopedic pro- grams,” she said.
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