Illinois
Illinois calls it the Health Facilities Planning Act. It should be called the Incumbent Protection Racket Act. One insurer controls 97% of the HMO market. The state's CON law is the moat that protects this castle, ensuring no new competition can threaten the cozy arrangement between dominant insurers and hospital systems.
What CON Covers in Illinois
Illinois's CON program is administered by the Health Facilities and Services Review Board (HFSRB). Incumbent providers can protest applications, creating a high barrier to entry for new competitors.
| Category | Services Requiring CON Approval |
|---|---|
| Facilities | Hospitals, Ambulatory Surgical Centers, Freestanding Emergency Centers, Birthing Centers |
| Long-Term Care | Nursing Homes, Long-Term Care Facilities |
| Specialty | Dialysis Centers |
The Application Process
The HFSRB reviews all applications for new healthcare facilities and major capital expenditures. The process allows incumbent providers to protest, effectively giving existing players a veto over new competition. Application fees can reach $150,000.
| Review Detail | Value |
|---|---|
| Reviewing Agency | Health Facilities and Services Review Board (HFSRB) |
| Application Fee | $5,000 or 0.22% of project cost (up to $150,000) |
| Statutory Review Timeline | 60 days |
| Can Competitors Intervene? | Yes. Incumbents can protest applications. |
| Sunset Clause | Law expires December 31, 2029 unless renewed |
Market Concentration in Illinois
In markets shielded by CON laws, a few large players inevitably dominate. Illinois is no exception, with massive health systems and a single insurer controlling nearly the entire HMO market.
Blue Cross/Blue Shield of Illinois controls nearly the entire HMO market.
The largest health system operating in Illinois.
Northwestern Medicine dominates the Chicago market.
Advocate Health Care is a major player in the Chicago suburbs.
Illinois Hospital System Revenue
Three systems dominate the state.
"When one company controls 97% of the HMO market, you don't have a market; you have a monopoly."— The Rojas Report analysis
When the System Says No
Behind every CON denial is a community denied access to care.
Edward Hospital — Plainfield Facility Denial
CON DeniedIn 2009, Edward Hospital applied to build a new hospital in Plainfield, a rapidly growing suburb west of Chicago. The community was underserved, and the hospital argued that a new facility was needed to meet growing demand.
The Health Facilities and Services Review Board denied the application. The hospital's CEO alleged the denial was retaliatory after she exposed a kickback scheme within the review process. Despite the allegations, the board formally rejected the CON, leaving the community without the facility it needed.
The case illustrates how the CON process can be weaponized — not just to protect incumbents from competition, but potentially to punish those who challenge the system itself.
"The denial wasn't about community need. It was about protecting the status quo."
The Path Forward
Illinois is one of the few states with a sunset clause on its CON law.
Illinois (Sunset 2029)
- ■CON program in place since 1974
- ■6+ services regulated
- ■Score: 75/100 (Restrictive)
- ■Law sunsets December 31, 2029
- ■97% HMO market controlled by BCBS
- ■Incumbent protest rights remain active
States That Reformed
- ■Indiana repealed CON in 1999 — prices dropped
- ■Ohio repealed CON — more ASCs opened
- ■Pennsylvania never had CON — competitive market
- ■Texas repealed CON — no quality decline
- ■New Hampshire repealed CON in 2016
- ■FTC & DOJ: CON laws reduce supply, raise costs
The Rojas Report Take
In Illinois, they call it the Health Facilities Planning Act. It should be called the "Incumbent Protection Racket Act." When one company, Blue Cross/Blue Shield of Illinois, controls 97% of the HMO market, you don't have a market; you have a monopoly. The state's CON law is the moat that protects this castle, ensuring no new competition can threaten the cozy arrangement between the dominant insurers and hospital systems.
Look at the players: CommonSpirit Health, Northwestern Medicine, and Advocate Health Care are not just healthcare providers; they are titans of a protected industry, shielded from competition by a regulatory board that has the power to deny new entrants. The 2009 denial of Edward Hospital's new facility in Plainfield is a textbook example of this protectionism in action.
The law may be set to expire in 2029, but until then, it's business as usual for the Illinois healthcare cartel. The question is whether the legislature will let the sunset happen — or whether the incumbents will spend enough to keep the lights on.
Related Investigations
Data sourced from Illinois Health Facilities and Services Review Board, Centers for Medicare & Medicaid Services (CMS), Federal Trade Commission, American Hospital Association, and Cicero Institute.