CON Score
65/100
RestrictiveNational Rank
#12/35
Of states with CON laws
Governor
Tina Kotek
CON Enacted
1971
ASC Regulation
Exempt
Psychiatric Beds
Regulated
Incumbent Standing
Yes
Scope of Regulation
What requires a state permission slip?
Regulated Services
- ◆New Hospitals
- ◆New Skilled Nursing Facilities
- ◆New Intermediate Care Facilities
- ◆New HMO-Owned Health Facilities
- ◇Ambulatory Surgical Centers (since 2009)
Application Process
Reviewing Body
Oregon Health Authority (OHA)
Application Fee
$5,000 - $90,900 (cost-based)
Review Timeline
90 days (standard)
Market Concentration
Who benefits from restricted competition?
Largest Health Systems
(by Oregon Revenue)
- 1. Providence: $6.26B
- 2. OHSU: $4.9B
- 3. Legacy Health: $2.88B
Largest Insurers
(by Market Share)
- 1. Kaiser Foundation: 23.6%
- 2. Regence BCBS: 16.5%
- 3. Providence Health Plan: 7.5%
Local Market Power
(HHI equivalent)
- Salem Health: ~80% market share in Marion/Polk counties.
- PeaceHealth: ~75% acute care share in Lane County.
The Human Cost
Notable cases and their impact.
Case File: NEWCO Oregon, Inc.
Psychiatric Hospital Denied
In 2017, the Oregon Health Authority denied a Certificate of Need for a proposed 100-bed freestanding psychiatric hospital in Wilsonville. The applicant, NEWCO, argued the state desperately needed more mental health capacity.
OHA concluded the project failed to meet multiple criteria, including need and cost-effectiveness, despite acknowledging the applicant's financial soundness. The denial sparked public controversy, with NEWCO framing it as an anticompetitive blockade by the state that ultimately harmed patients in need of care.
Reform Status
Where does Oregon stand on CON reform?
Key Reforms
Oregon has made some progress. The most significant reform was the exemption of Ambulatory Surgical Centers (ASCs) from CON review in 2009. This was a critical step, opening the door for more competition in outpatient surgery.
However, the core of the law, which covers new hospitals and long-term care facilities, remains firmly in place, preserving the gatekeeping power of the state and incumbent providers.
Recent Activity
The Oregon Health Authority adopted temporary rule changes in late 2025 affecting hospital and psychiatric bed CON methodology. While positioned as updates, they don't represent a fundamental shift away from the CON regime.
The state's score of 65 reflects this mixed reality: a major reform in the past, but a system that still significantly restricts market entry for core healthcare facilities.
The Rojas Report Take
Oregon presents a classic case of partial reform being used as a shield against fundamental change. While exempting Ambulatory Surgical Centers was a laudable move, it was over a decade ago. Today, the state's healthcare landscape is a story of entrenched monopolies. Providence and its affiliated health plan control a massive swath of the market, pulling in over $6.2 billion in revenue while also insuring nearly 700,000 residents. In markets like Salem and Lane County, single systems dominate with near-total control, holding 80% and 75% market share, respectively.
The 2017 denial of a 100-bed psychiatric hospital is a stark reminder of who these laws truly serve. At a time of a national mental health crisis, the state's bureaucracy decided an area didn't "need" more beds, a decision that conveniently protected existing players. Oregon's CON law isn't a tool for ensuring quality; it's a barrier to entry that inflates costs and limits patient choice.
It's time to finish the job started in 2009: dismantle the rest of this archaic system.