- CON laws were designed to reduce the supply of hospitals and hospital beds. Research confirms they have accomplished this. Patients in the average CON state have access to fewer hospitals, fewer ambulatory surgical centers (ASCs), fewer dialysis facilities, fewer imaging centers, and fewer rural hospitals per capita, among other things.
- The rising tide of competition lifts all boats. States without CON laws have more hospitals, more ASCs, more rural hospitals, and more rural ASCs per capita—dispelling the myth that hospitals close without cross-subsidization.
- In fact, research finds that CON laws have no effect on cross-subsidization and do not increase charity care.
- CON laws have been studied extensively and 89% of academic tests find a bad or neutral outcome. For every test associating CON laws with a “good” result, there are five that associate them with a “bad” result.
- Critics worry that repealing CON laws will force rural and safety-net hospitals to close. But that hasn’t happened in the dozen states that have successfully repealed CON laws:
- One study found that four years after Pennsylvania repealed its CON laws, no hospital closures had been reported and incumbent hospitals were moreprofitable than new facilities.
- Another study found that safety-net hospitals have higher profit margins in states without CON laws.
- CON laws are not what keep rural hospitals from closing. Several states with zero CON laws, like CO, ID, UT, and WY, have had zero rural hospital closures since at least 2005.
- And many states with CON laws exempt rural hospitals or rural facilities from their CON requirements: AL, IN, KY, MT, OH, OR, SC, TN, WA.
- Kentucky’s CON application process advantages existing providers. When incumbent providers opposed the applications of would-be competitors, approval rates fell by nearly half and the time until a final decision was extended by an average of five months. Many innovators give up without applying.
- Research shows that states with CON laws were 27% more likely to run out of hospital beds during COVID-19 surges, regardless of whether the states temporarily eased their CON laws during the pandemic or not.
- Determining whether a service is “needed” (and thus whether a CON can be granted) in Kentucky depends on outdated, inelastic formulas. These formulas rely on metrics like population and past usage, but ignore real, on-the-ground evidence of need.
- Doctors and patients, not government officials, should decide when care is needed. Twice in 2023, Governor Andy Beshear was forced to override CON regulations to address dangerously low access to healthcare—once for mental health services and again for ambulance services. It didn’t have to be like this. Providers filed CON applications to expand these services over the past few years, but the Cabinet denied them, leading to the present crisis.
- The Federal Trade Commission and Antitrust Divisions of the Department of Justice have advocated for CON law repeal since the Reagan administration. Their position has remained consistent across both Republican and Democratic administrations. Other agencies, like the U.S. Department of Health and Human Services, Department of Labor, and Department of the Treasury also agree.
