It’s past time for NC to can CON laws  

Many of us are familiar with Einstein’s quip that “the definition of insanity” is doing the same thing over and over again and expecting different results. This also applies to North Carolina’s use of Certificate Of Need (CON) laws, where we continue to do the same thing and are surprised that our health costs do not come down.

And the most insane part of this is that the citizens of North Carolina are the ones paying the high price for health care. Simple common-sense math tells us that less competition in the marketplace equals higher costs. Think about it this way, if we only had one grocery store to buy groceries from, imagine how expensive the groceries would be. Because we have several choices from where we can buy groceries, competition allows us to shop for less. Affordable health care is possible in this way too, but only if the North Carolina General Assembly repeals or considers a compromise on North Carolina’s CON laws.  

The madness began in 1974 when the federal government required all states to implement CON laws. The goal was to reduce health care costs, improve planning, and avoid duplication of services provided in any given area. This was nothing more than a federal mandated experiment. What this “requirement” by the federal government did, in fact, was the exact opposite. It reduced competition, protected existing hospitals from new entrants, and limited innovation. In 1986, Congress repealed the mandate, and states were no longer required to have CON programs. Some states, like Texas and California, repealed their CON laws. Most other states either kept CON laws as is or modified them. As of today, 30-35 states, including DC, have some form of CON laws. However, the scope varies widely.  

Here is a true story that hits close to my home. On a Friday in March of 2025, my father was rushed to UNC Johnston in Clayton. Allow me to say that the staff (from the front desk to the doctors) genuinely are nice, polite, and give the utmost care to each patient that is seen there. He was in a room in the emergency department for 24 hours. He called my brother and I to inform us that he was being transferred to UNC Johnston in Smithfield, which is approximately 12 miles from Clayton. The reason for him being transferred? There were no rooms available. So, he stayed at UNC Johnston in Smithfield until Sunday afternoon and was released that day. North Carolina’s CON laws — and the CON board that decides which hospital gets to add more rooms, medical equipment, and who can build a hospital and where — are to blame for the lack of rooms. 

In late February of this year, state Sen. Benton Sawrey of Johnston County spoke at the 2026 Carolina Liberty Conference about CON laws, where he stated, “You would think that UNC in Johnston County could make a decision about whether they need new beds. And they need new beds, and they asked the state for beds back in 2020. And the state said, wait, we don’t think there’s a need for them.”

He asked this very important question, “Why does a group of bureaucrats in Health and Human Services get to make a determination on what’s best for Johnston County?”  

Sawrey continued by saying that “the county continued to wait until 2025.” And after five years, the state decided to allow UNC Health in Johnston County to have… 12 beds. Just another example of the insanity of CON laws. Johnston County is just one county out of the 100 in North Carolina that are dealing with this same problem.  

The hospitals we have currently in our region (and, across the state) want to add rooms and medical equipment, file for CONs, and when they get denied, they blame CON. However, when a hospital has more rooms and/or medical equipment to provide for their patients and another hospital is denied a CON for more rooms and/or medical equipment, they praise CON.  

A commonsense solution to fixing the problem of CON laws would be a full repeal. Another option is a compromise to implement a “Use It or Lose It” model. Currently, when a hospital or health care facility receives approval for a CON, they can hold on to it for what seems an eternity, not using buying the MRI machine or adding the beds while also preventing other providers from doing so (since they don’t have the CON). That does nothing more than hurt you, me, and OUR families that want the best health care at a lower cost. The last solution would be to place a sort of moratorium on CON laws for say, two years. Let it play out over that time and monitor it to see how it works.  

If you are tired of the same thing being done over and over again and expecting different results, reach out to your representatives at the General Assembly and let your voice be heard! Tell them to repeal CON laws, or at least reach a commonsense solution that will help all North Carolinians. Our lives depend on the right decision being made by our legislators.  

“It’s past time for NC to can CON laws  ” was originally published on www.carolinajournal.com.