Certificate-of-Need Laws
Certificate-of-need (CON) laws require healthcare providers to seek permission from state regulators before they offer new services, expand facilities, or invest in technology. While the original hope was that CON laws would restrain healthcare costs, increase healthcare quality, and improve access to care for poor and underserved communities, a large body of academic research suggests that CON laws have instead limited access, degraded quality, and increased cost.
Despite this poor track record, CON laws remain in most states, keeping millions of Americans from getting the care they need.
Latest work in Certificate-of-Need Laws
- | Healthcare Healthcare
- | State Testimonies State Testimonies
South Carolina's Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
- | Healthcare Healthcare
- | Policy Briefs Policy Briefs
North Carolina’s Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Alaska's Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
Alaska Senate Finance Committee
- | Healthcare Healthcare
- | State Testimonies State Testimonies
West Virginia's Certificate-of-Need Program: Five Numbers Everyone Should Know about CON
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Missouri's Certificate-of-Need Program: Lessons from Research
- | Expert Commentary Expert Commentary
It’s Time for States to Ditch Certificate-of-Need Laws
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
Why Is CON Still in Alaska?
CON laws are little more than expensive and time-consuming barriers to care.
- | Healthcare Healthcare
- | State Testimonies State Testimonies
South Carolina's Certificate-of-Need Program: Lessons from Research
Testimony before the South Carolina Senate, Medical Affairs Committee, Certificate-of-Need Subcommittee
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
A Missed Opportunity To Expand WV Health Care
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Alaska's Certificate-of-Need Program: Lessons from Research
Testimony before the Senate Labor and Commerce Standing Committee of the Alaska State Legislature
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Benefits to Patients and Providers in Alaska With the Removal of CON Laws
- | Healthcare Healthcare
- | Publication
Minnesota and Certificate-of-Need Programs 2020
How CON laws Affect Health Care Access, Quality, and Cost in Minnesota
- | Healthcare Healthcare
- | Publication
Wisconsin and Caps on Healthcare Service 2020
While Wisconsin does not have a certificate-of-need program, it does cap five healthcare services
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Maine’s Certificate-of-Need Program: Lessons from Research
Testimony before the Maine Joint Committee on Health Coverage, Insurance, and Financial Services
- | Healthcare Healthcare
- | Publication
North Carolina and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in North Carolina
- | Healthcare Healthcare
- | Publication
Virginia and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Virginia
- | Healthcare Healthcare
- | Publication
Maryland and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Maryland
- | Healthcare Healthcare
- | Publication
Massachusetts and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Massachusetts
- | Healthcare Healthcare
- | Publication
Michigan and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Michigan
- | Healthcare Healthcare
- | Publication
Vermont and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Vermont
Latest work in Certificate-of-Need Laws
- | Healthcare Healthcare
- | State Testimonies State Testimonies
South Carolina's Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
- | Healthcare Healthcare
- | Policy Briefs Policy Briefs
North Carolina’s Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Alaska's Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
Alaska Senate Finance Committee
- | Healthcare Healthcare
- | State Testimonies State Testimonies
West Virginia's Certificate-of-Need Program: Five Numbers Everyone Should Know about CON
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Missouri's Certificate-of-Need Program: Lessons from Research
- | Expert Commentary Expert Commentary
It’s Time for States to Ditch Certificate-of-Need Laws
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
Why Is CON Still in Alaska?
CON laws are little more than expensive and time-consuming barriers to care.
- | Healthcare Healthcare
- | State Testimonies State Testimonies
South Carolina's Certificate-of-Need Program: Lessons from Research
Testimony before the South Carolina Senate, Medical Affairs Committee, Certificate-of-Need Subcommittee
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
A Missed Opportunity To Expand WV Health Care
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Alaska's Certificate-of-Need Program: Lessons from Research
Testimony before the Senate Labor and Commerce Standing Committee of the Alaska State Legislature
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Benefits to Patients and Providers in Alaska With the Removal of CON Laws
- | Healthcare Healthcare
- | Publication
Minnesota and Certificate-of-Need Programs 2020
How CON laws Affect Health Care Access, Quality, and Cost in Minnesota
- | Healthcare Healthcare
- | Publication
Wisconsin and Caps on Healthcare Service 2020
While Wisconsin does not have a certificate-of-need program, it does cap five healthcare services
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Maine’s Certificate-of-Need Program: Lessons from Research
Testimony before the Maine Joint Committee on Health Coverage, Insurance, and Financial Services
- | Healthcare Healthcare
- | Publication
North Carolina and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in North Carolina
- | Healthcare Healthcare
- | Publication
Virginia and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Virginia
- | Healthcare Healthcare
- | Publication
Maryland and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Maryland
- | Healthcare Healthcare
- | Publication
Massachusetts and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Massachusetts
- | Healthcare Healthcare
- | Publication
Michigan and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Michigan
- | Healthcare Healthcare
- | Publication
Vermont and Certificate-of-Need Programs 2020
How CON Laws Affect Healthcare Access, Quality, and Cost in Vermont
Latest work in Certificate-of-Need Laws
- | Healthcare Healthcare
- | Policy Briefs Policy Briefs
North Carolina’s Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
- | Healthcare Healthcare
- | Policy Briefs Policy Briefs
Public Health in Rural States: The Case against Certificate-of-Need Laws
- | Healthcare Healthcare
- | Working Papers Working Papers
Examining Certificate-of-Need Laws in the Context of the Rural Health Crisis
- | Healthcare Healthcare
- | Policy Briefs Policy Briefs
Raising the Bar: ICU Beds and Certificates of Need
- | Healthcare Healthcare
- | Policy Briefs Policy Briefs
A Fresh Start: How to Address Regulations Suspended during the Coronavirus Crisis
- | Corporate Welfare Corporate Welfare
- | Policy Briefs Policy Briefs
First, Do No Harm: Three Ways That Policymakers Can Make It Easier for Healthcare Professionals to Do Their Jobs
- | Healthcare Healthcare
- | Policy Briefs Policy Briefs
Phasing Out Certificate-of-Need Laws: A Menu of Options
While full repeal is best, policymakers have several options for reforming CON laws
- | Healthcare Healthcare
- | Policy Briefs Policy Briefs
POLICY SPOTLIGHT: Increasing Access to Quality, Lower-Cost Healthcare in Vermont
A Policy Recommendation
- | Corporate Welfare Corporate Welfare
- | Policy Briefs Policy Briefs
Certificate-Of-Need Laws 2017: How CON Laws Affect Spending, Access, and Quality across the States
- | Corporate Welfare Corporate Welfare
- | Working Papers Working Papers
The Effect of Interest Group Pressure on Favorable Regulatory Decisions
The Case of Certificate-of-Need Laws
- | Corporate Welfare Corporate Welfare
- | Working Papers Working Papers
Barriers to Entry in the Healthcare Markets
Winners and Losers from Certificate-of-Need Laws
- | Academic & Student Programs Academic & Student Programs
- | Corporate Welfare Corporate Welfare
- | Policy Briefs Policy Briefs
Illinois’s Certificate-of-Need Laws: Effects on Quality, Spending, and Access to Care

- | Corporate Welfare Corporate Welfare
- | Working Papers Working Papers
Do Certificate-of-Need Laws Limit Spending?
- | Corporate Welfare Corporate Welfare
- | Working Papers Working Papers
Certificate-of-Need Laws and Hospital Quality
- | Healthcare Healthcare
- | Working Papers Working Papers
Can Health Spending Be Reined In through Supply Constraints? An Evaluation of Certificate-of-Need Laws
- | Corporate Welfare Corporate Welfare
- | Data Visualizations Data Visualizations
The Impact of Certificate-of-Need Laws on Community Hospitals and Ambulatory Surgery Centers

- | Healthcare Healthcare
- | Data Visualizations Data Visualizations
Impact of Certificate-of-Need Laws on the Provision of Medical Imaging Services

- | Corporate Welfare Corporate Welfare
- | Working Papers Working Papers
Are Certificate-of-Need Laws Barriers to Entry? How They Affect Access to MRI, CT, and PET Scans
Latest work in Certificate-of-Need Laws
- | Corporate Welfare Corporate Welfare
- | Mercatus Original Video Mercatus Original Video
Certificate of Needs Laws in Health Care: Lessons from Research
Latest work in Certificate-of-Need Laws
- | Healthcare Healthcare
- | State Testimonies State Testimonies
South Carolina's Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Alaska's Certificate-of-Need Program: Three Numbers Everyone Should Know about CON Laws
Alaska Senate Finance Committee
- | Healthcare Healthcare
- | State Testimonies State Testimonies
West Virginia's Certificate-of-Need Program: Five Numbers Everyone Should Know about CON
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Missouri's Certificate-of-Need Program: Lessons from Research
- | Healthcare Healthcare
- | State Testimonies State Testimonies
South Carolina's Certificate-of-Need Program: Lessons from Research
Testimony before the South Carolina Senate, Medical Affairs Committee, Certificate-of-Need Subcommittee
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Alaska's Certificate-of-Need Program: Lessons from Research
Testimony before the Senate Labor and Commerce Standing Committee of the Alaska State Legislature
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Benefits to Patients and Providers in Alaska With the Removal of CON Laws
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Maine’s Certificate-of-Need Program: Lessons from Research
Testimony before the Maine Joint Committee on Health Coverage, Insurance, and Financial Services
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Washington’s Certificate-of-Need Program: Lessons from Research
Testimony before the Washington State Legislature, House Health Care and Wellness Committee
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Tennessee's Certificate-of-Need Program: Lessons from Research
Testimony before the Tennessee Certificate-of-Need Working Group
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Alaska's CON Law: Lessons from Three Decades of Research
Testimony before the Alaska Senate Health and Social Services Committee
- | Healthcare Healthcare
- | Federal Testimonies Federal Testimonies
Better Health for More People at Lower Cost, Year after Year: Greatest Opportunities to Improve America’s Unbroken, but Underperforming Healthcare System
Submitted to the Senate Committee on Health, Education, Labor, and Pensions
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Florida's CON Law: Lessons from Three Decades of Research
Testimony before the Florida House of Representatives, Health Market Reform Subcommittee
- | Urban Economics Urban Economics
- | State Testimonies State Testimonies
The Failure of Georgia’s Certificate-Of-Need Laws
Testimony before the Georgia House of Representatives Rural Development Council
- | Corporate Welfare Corporate Welfare
- | State Testimonies State Testimonies
Virginia’s Certificate-of-Public-Need Law: A Comparison with Other States
Testimony before the Virginia House of Delegates; Health, Welfare, and Institutions Committee
- | Healthcare Healthcare
- | State Testimonies State Testimonies
The Failure of Alaska’s Certificate-of-Need Laws
Testimony before the Alaska Senate Labor and Commerce Committee, Hearing on Repeal of Certificate of Need Program

- | State Testimonies State Testimonies
The Failure of West Virginia’s Certificate-of-Need Program
Testimony before the West Virginia Senate Health and Human Resources Committee

- | Corporate Welfare Corporate Welfare
- | State Testimonies State Testimonies
Do Certificate-of-Need Laws Reduce Spending?
Testimony before the Florida Health Innovation Subcommittee
- | Healthcare Healthcare
- | State Testimonies State Testimonies
Certificate-of-Need Laws: Implications for New Hampshire
Testimony before the New Hampshire House Health, Human Services and Elderly Affairs Committee
Latest work in Certificate-of-Need Laws
- | Expert Commentary Expert Commentary
It’s Time for States to Ditch Certificate-of-Need Laws
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
Why Is CON Still in Alaska?
CON laws are little more than expensive and time-consuming barriers to care.
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
A Missed Opportunity To Expand WV Health Care
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
The Real Cost of CON Laws: Quality of Care Under Pressure During the Pandemic
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
The Real Cost of CON Laws: The Long, Hard Road to State Approval
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
The Real Cost of CON Laws: Imperiling the American Dream
- | Expert Commentary Expert Commentary
The Human Cost of Outdated Regulations
One mother’s story vividly shows the real-world impact of certificate-of-need laws

- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
The Human Cost of Outdated Regulations
- | Corporate Welfare Corporate Welfare
- | Expert Commentary Expert Commentary
Let’s Fix the Laws Around Hospital Capacity Before the Next Health Crisis
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
How More States Can Free up Emergency Health Care
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
Now is the Time to Eliminate Certificate-of-Need Laws that Limit Hospital Resources and Space for Patients
Hospital staff, not state administrators, should decide how many beds a facility needs.

- | Technology and Innovation Technology and Innovation
- | Expert Commentary Expert Commentary
FTC's New Economic Liberty Task Force Is a Step in Right Direction
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
Certificate-of-Need Programs Backfire
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
The Health Care Laws You Should Be Paying Attention to (and Probably Aren't)
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
Little-Known State Laws Are Hurting Patients and Making Hospitals Worse
- | Urban Economics Urban Economics
- | Expert Commentary Expert Commentary
Time to Tear down the Walls to Healthcare
- | Urban Economics Urban Economics
- | Expert Commentary Expert Commentary
Ryan Is Right to Tackle Federal Regulations, but We Must Look at State and Local, Too
- | Corporate Welfare Corporate Welfare
- | Expert Commentary Expert Commentary
Rural Virginians Pay Steep Price for failing Policy
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary
Certifiably Needless Health-Care Meddling
- | Healthcare Healthcare
- | Expert Commentary Expert Commentary