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🔵 Certificate of Need (CON) laws:
North Carolina requires healthcare providers to get government permission to open or expand, aiming to control costs and protect small hospitals.
🔵 The Problem:
CON laws limit competition, drive up healthcare costs, block entrepreneurs, and reduce patient access to new clinics and services.
🔵 The Solution — Senate Bill 370:
The NC General Assembly is considering a bill to fully repeal CON laws, opening the door to more healthcare options, lower prices, and innovation starting January 1, 2026.
Here’s your educational article, about 800 words, written clearly for a high school-level reader, combining information from the Washington Post article, the bill (Senate Bill 370), and your instructions:
Imagine if every time someone wanted to open a new restaurant in your town, they first had to ask permission from all the other restaurant owners — and the government could say no if it decided there were already “enough” places to eat.
That’s how Certificate of Need (CON) laws work in health care.
In North Carolina and 35 other states, hospitals, clinics, and even surgery centers must obtain special permission from the government before they can expand or open new facilities. They need a “Certificate of Need” — a legal document saying the government agrees more healthcare is “needed” in that area.
But that might be about to change.
Today, the North Carolina General Assembly is hearing a bill — Senate Bill 370 [ [link removed] ]— that would repeal the state’s Certificate of Need laws. If it passes, North Carolina would open the door to many more healthcare businesses, increased competition, and expanded patient choices.
Over the years, numerous legislative attempts have been made to repeal or modify these laws. Notably, in 2023, as part of Medicaid expansion negotiations, lawmakers passed partial reforms that eliminated CON requirements for certain services, such as behavioral health beds and specific diagnostic centers.
During this year’s legislative session, several bills, including Senate Bill 370, were introduced to fully repeal the Certificate of Need (CON) laws, reflecting ongoing debates about their impact on healthcare access and competition.
What Are Certificate of Need Laws?
Certificate of Need laws were first created in the 1970s.
At the time, leaders worried that if hospitals continued to build more facilities, it would cause healthcare costs to spiral out of control. They thought new hospitals and medical centers might create too many expensive services (like MRI machines or surgical suites) and then push patients to use them — driving up bills for everyone.
To address this, states like North Carolina have passed laws that require healthcare providers to demonstrate a genuine "need" before constructing new facilities or offering expensive new services.
In theory, it would prevent waste, keep costs low, and ensure hospitals didn’t build things solely to generate revenue.
How Certificate of Need Laws Can Help Patients
CON laws sound good — and in some ways, they are helpful:
Prevents overspending: Hospitals can be costly to build and operate. CON laws try to avoid wasting money on buildings that few patients use.
Protects small, rural hospitals: Without CON laws, bigger hospitals in cities might open nearby and pull patients (and money) away from small town hospitals, possibly forcing them to close.
Focuses resources: CON laws can encourage communities to prioritize services that are truly needed, like trauma centers or cancer treatment units.
North Carolina’s CON law aims to ensure that healthcare grows wisely, not just based on who has the most money.
How Certificate of Need Laws Hurt Healthcare Supply and Entrepreneurs
But over time, critics have noticed that CON laws create serious problems too:
Limits Competition: Existing hospitals and clinics can use CON laws to block new competitors. If someone wants to open a new surgery center, the nearby big hospital can argue that it's "not needed" — and keep patients with fewer choices.
Drives Up Costs: Less competition often means higher prices. In North Carolina, medical procedures at hospital-run centers typically cost significantly more than those at independent clinics, according to a report [ [link removed] ] from The Washington Post.
Slows Innovation: Entrepreneurs — inventors and entrepreneurs who introduce new ideas to healthcare — struggle to establish businesses when they must navigate government paperwork, expensive legal fees, and lengthy appeals just to open a new medical office.
Reduces Access: Patients in fast-growing areas may have to wait longer for surgeries or treatments because new facilities cannot open quickly enough to meet demand.
Some states that have repealed their Certificate of Need (CON) laws — such as Texas and Florida — have seen increased healthcare options, lower prices, and faster services for patients.
What Senate Bill 370 Would Do
The bill heard today — Senate Bill 370 — would fully repeal North Carolina’s Certificate of Need laws.
Here’s what it would change:
No More Permission Needed: Hospitals, clinics, surgery centers, and other healthcare providers could open or expand without getting a CON.
More Healthcare Businesses: Entrepreneurs could start new medical practices more easily, offering patients more options.
More Competition: Big hospital systems would have to compete more fiercely to attract patients, potentially leading to improved service and lower costs.
Pressure on Rural Hospitals: Some worry that without Certificate of Need (CON) laws, rural hospitals could struggle if patients choose newer, larger hospitals instead.
If passed, the repeal would take effect January 1, 2026.
Conclusion: Balancing Protection and Progress
In simple terms, Certificate of Need laws were designed to protect communities from healthcare waste and inequality.
But today, many believe they are hurting more than helping by blocking competition, raising prices, and limiting patient choices.
North Carolina now faces a big decision:
Should the government keep protecting the old system, or open healthcare up to innovation and new businesses?
Repealing the Certificate of Need law could create a faster, cheaper, and more patient-centered healthcare system — but it could also challenge hospitals that serve vulnerable communities.
Either way, it’s a choice that will shape healthcare in North Carolina for decades to come.

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