What Happens After Repeal?
Every CON reform bill faces the same opposition testimony: 'repeal will close rural hospitals.' These three states provide the answer, with data.
Florida
Eliminated CON for general hospitals. Retained requirements for nursing homes, hospice, and intermediate care facilities.
| Metric | Before Reform | After Reform | Trend |
|---|---|---|---|
| Hospital CON applications (pre-reform annual avg) | ~40 | N/A (eliminated) | ↑ |
| New hospital construction permits (2020-2024) | Restricted | 12+ new projects announced | ↑ |
| ASC count | 410 (2018) | 480+ (2024) | ↑ |
| Hospice providers (still under CON) | Limited | Still restricted | — |
| Rural facility openings | Minimal | 3 new rural hospitals announced | ↑ |
Florida's partial repeal demonstrated that removing hospital CON does not lead to facility closures or quality decline. New construction projects surged, particularly in high-growth markets.
Source: Florida Agency for Health Care Administration, CMS Provider of Services File
Montana
Eliminated CON for most healthcare services. Limited scope remains for certain facilities.
| Metric | Before Reform | After Reform | Trend |
|---|---|---|---|
| Regulated service categories | 12+ | 2-3 (limited) | ↑ |
| New facility applications (post-reform) | ~5/year | 15+ in first 2 years | ↑ |
| Rural healthcare access | Limited by CON barriers | New clinics in underserved counties | ↑ |
| Incumbent opposition filings | Common | Eliminated for most services | ↑ |
| Healthcare spending trend | Above national average | Tracking closer to national average | — |
Montana's repeal eliminated the incumbent veto power for most services. New facility applications tripled in the first two years, with rural areas seeing the most benefit.
Source: Montana DPHHS, Cicero Institute post-repeal analysis
South Carolina
Began phased elimination of CON requirements. Full repeal scheduled to complete by 2027.
| Metric | Before Reform | After Reform | Trend |
|---|---|---|---|
| CON restrictiveness score (Cicero) | 35/100 | Declining (repeal in progress) | ↑ |
| Regulated service categories | 10+ | Phasing out through 2027 | ↑ |
| New facility announcements | Baseline | Too early to measure | — |
| Hospital opposition filings | Active | Declining as repeal phases in | ↑ |
| Legislative support | Divided | Bipartisan majority | ↑ |
South Carolina's phased approach provides a real-time test case. Early indicators show declining incumbent opposition and bipartisan support for continued reform.
Source: SC DHEC, State Legislature records
The data is clear.
States that reform their CON laws see more facilities, more competition, and better access, especially in rural areas. No state that has repealed its CON law has reversed course.