How We Got Here
From a 1959 academic study to a federal mandate to 35 jurisdictions that still restrict healthcare competition. This is the timeline of Certificate of Need.
Hill-Burton Act funds hospital construction, creating the infrastructure CON laws would later protect
Milton Roemer publishes UCLA study correlating hospital bed supply with utilization — the hospital industry twists it into a justification for restricting competition
New York enacts the first Certificate of Need law in the United States
American Hospital Association campaigns for nationwide CON adoption to limit competition
Social Security Amendments (Section 1122) tie federal funding to state planning review — CON becomes a federal priority
National Health Planning and Resources Development Act (PL 93-641) signed by President Ford — effectively mandates CON in all states by threatening to withhold federal funds
Peak CON adoption: nearly every state has enacted a CON program
Federal CON mandate repealed after being deemed ineffective — 14 states repeal their CON laws over the next decade, but 36 keep them
FTC and DOJ issue joint report finding CON laws pose 'serious anticompetitive risks' and recommending repeal
Tiwari v. Meier filed in Kentucky — a Nepali immigrant challenges CON after being blocked from serving refugees with home health care
Florida partially repeals its CON law, eliminating requirements for general hospitals while keeping nursing home and hospice restrictions
Montana passes CON reform, limiting the scope of its certificate of need program
U.S. Supreme Court declines to hear Tiwari v. Meier, leaving Kentucky's CON law intact
Georgia passes HB 1339, beginning incremental CON reform. South Carolina begins its repeal process.
35 jurisdictions (34 states + DC) still enforce CON laws. The architecture remains.
They didn't prove waste. They proved access.
The Rojas Report, on Roemer's Law