Georgia
Georgia's CON laws, enacted in 1979, regulate a broad range of healthcare services. This has led to highly concentrated markets, exemplified by the Albany area, where one system, Phoebe Putney, controls 86% of the market.
What CON Covers in Georgia
Georgia's CON program is administered by the Department of Community Health. Competitors are explicitly allowed to participate in opposition meetings to object to new applications.
| Category | Services Requiring CON Approval |
|---|---|
| Facilities | Hospitals, destination cancer hospitals, skilled nursing facilities, intermediate care facilities, personal care homes, ambulatory surgical centers, obstetrical facilities, freestanding emergency departments, health maintenance organizations, home health agencies |
| Services & Centers | Special care units, diagnostic, treatment, or rehabilitation centers |
The Application Process
The statutory timeline for a review is 120 days, with the actual process taking about four months. A key feature of Georgia's process is the formal 'opposition meeting,' which allows incumbent providers a platform to officially contest applications from potential new competitors.
| Review Detail | Value |
|---|---|
| Reviewing Agency | Georgia Department of Community Health |
| Application Fee | $1,000 to $50,000 |
| Statutory Review Timeline | 120 days |
| Actual Review Timeline | ~4 months |
| Can Competitors Intervene? | Yes, via formal 'opposition meetings' |
Who Benefits
Georgia's CON laws have created a landscape where large hospital systems face little competition, leading to near-monopolies in certain regions and high market concentration.
An HHI above 2,500 is "highly concentrated." 7,453 indicates an extreme monopoly.
Source: FTC v. Phoebe Putney
Phoebe Putney Health System controls 86% of the acute care hospital market in the six-county Albany area.
Source: U.S. Supreme Court
UnitedHealth Group is the largest insurer, but the market is less concentrated than in other CON states.
Source: State Filings
The top 3 hospital systems (Northside, Piedmont, Wellstar) collectively generate over $18.6B in revenue.
Source: System Financials
Atlanta Hospital Market Share (Estimated)
Three large systems dominate the Atlanta metropolitan area, collectively controlling a significant majority of the market based on revenue.
"When a single hospital can acquire a dominant share of the market, it can exercise significant market power, which, in turn, can lead to higher prices for healthcare services."
— U.S. Supreme Court, FTC v. Phoebe Putney Health System, Inc.
The Human Cost
The Phoebe Putney case reveals how CON-facilitated monopolies can harm a community, leading to a federal antitrust challenge that reached the Supreme Court.
FTC v. Phoebe Putney Health System, Inc.
Decided February 2013 · U.S. Supreme Court
In 2011, Phoebe Putney Health System, which already owned one of the two hospitals in Albany, Georgia, sought to acquire the second, Palmyra Medical Center. The acquisition was orchestrated through a hospital authority, a public entity, in an attempt to shield the merger from federal antitrust scrutiny using the state-action immunity doctrine.
The merger would give Phoebe Putney control of 86% of the acute-care hospital services market in the surrounding six-county area. The Federal Trade Commission (FTC) challenged the merger, arguing it would create a monopoly, reduce competition, and lead to higher prices for patients.
The case went to the U.S. Supreme Court, which unanimously ruled that the state-action immunity did not apply. The Court found that Georgia's CON law, while regulating hospital expansion, did not clearly articulate a state policy to displace competition with monopoly. The ruling was a major victory for antitrust enforcement in the healthcare sector.
"The residents of Albany-Dougherty County and the surrounding area would be better served by a competitive healthcare market. The proposed merger would be a step in the wrong direction."
— Federal Trade Commission Statement
Reform Status
Georgia has amended its CON law multiple times, most recently in 2024, but has not pursued a full repeal. The changes often add exemptions rather than dismantle the core regulatory structure.
Georgia (No Full Repeal)
- CON program in place since 1979
- 11 broad categories regulated
- Score: 95/100 (most restrictive)
- 2024 bill (HB 1339) revised process, added exemptions
- Albany HHI: 7,453 (near-total monopoly)
- Top 3 systems generate $18.6B+ revenue
States That Reformed
- Florida (2019): Repealed most CON requirements
- South Carolina (2023): Full repeal, hospital CON sunsets 2027
- Tennessee (2021): Repealed CON for non-hospital services
- ASCs per capita increased 44-47% after repeal
- Hospital charges 5.5% lower five years after repeal
- FTC/DOJ: CON laws increase costs and reduce quality
The Rojas Report Take
Georgia's Certificate of Need law is a state-sanctioned protection racket, plain and simple. It's a system where the house always wins, and the house is owned by hospital giants like Northside, Piedmont, and Wellstar. They're not competing; they're collaborating to keep the market locked down, and the state's CON program is their enforcement arm.
The Phoebe Putney case in Albany is the poster child for this corruption. An 86% market share isn't a market; it's a monopoly. The fact that it took the Federal Trade Commission and the Supreme Court to unwind it tells you everything you need to know. The regulators in Atlanta aren't protecting patients; they're protecting the profits of the hospital cartel.
It's time to burn the whole rotten system to the ground.
Related Content
The National CON Investigation
The full origin story of Certificate of Need laws and our 50-state rankings on market restrictiveness.
State ProfileKentucky: A 100/100 Score
Explore the nation's most restrictive CON state, where three systems control 100% of the Louisville market.
FTC v. Phoebe Putney: Full Analysis
A deep dive into the Supreme Court case that challenged a CON-enabled hospital monopoly in Georgia.
InvestigationData sourced from the Georgia Department of Community Health, U.S. Supreme Court, Federal Trade Commission, and state financial disclosures.