With CON laws repealed for hospitals, surgery centers, and imaging, the competitive landscape for most healthcare services is open. Market concentration is driven by geography and business strategy, not regulation. The two largest systems, Billings Clinic and Providence Health, dominate through scale and network effects, particularly in more populated areas.

The remaining CON law specifically protects existing nursing homes from competition, potentially leading to higher costs and lower quality within that niche sector by creating local monopolies for long-term care.

Unlike states with expansive CON programs where regulations are a primary barrier to new services, Montana's challenge is different. The state's low population density and large distances between communities create "medical deserts" where access is limited simply because the population cannot sustain a wide variety of facilities. The repeal of most CON laws allows providers to establish services where they see a viable market without government permission, which is critical in such an environment. The "human cost" is therefore a function of natural market limitations and geography, a problem that CON laws would likely exacerbate, not solve.