Virginia
Virginia's CON laws, in place since 1973, regulate 19 different services. This extensive regulation has led to highly concentrated hospital markets, limiting patient choice and shielding incumbent providers from competition.
What CON Covers in Virginia
Virginia's COPN program is administered by the Virginia Department of Health. Incumbent providers can actively participate in the review process to object to new competitors.
| Category | Services Requiring CON Approval |
|---|---|
| Facilities | Hospitals, Nursing Homes, Ambulatory Surgical Centers (ASCs), Psychiatric Hospitals, Rehabilitation Hospitals |
| Equipment | Medical Equipment (MRI, PET, CT scanners), Lithotripsy, Radiation Therapy |
| Services | Organ Transplantation, Open Heart Surgery, Neonatal Special Care, Substance Abuse Treatment |
| Other | Home Health Agencies, Hospice, Capital expenditures exceeding $15 million |
The Application Process
| Review Detail | Value |
|---|---|
| Reviewing Agency | Virginia Department of Health |
| Application Fee | Varies |
| Review Timeline | 90-180 days |
| Can Competitors Intervene? | Yes |
Who Benefits From CON in Virginia?
CON laws often lead to consolidated markets, where a few large players dominate. This reduces competition and can lead to higher prices for consumers.
Virginia Hospital System Revenue
A few large systems control the majority of hospital revenue in Virginia, a sign of a concentrated market.
The Human Cost of CON
The stories of those denied care or the ability to provide it.
Colon Health Centers v. Virginia
MRI Machine Denial
In 2015, a federal court ruled against a physician who challenged the CON law after being denied a certificate to purchase a second MRI machine for his independent practice. The court upheld the state's right to regulate, showcasing how the law prevents providers from expanding services based on demand.
"The court found that the COPN law's burdens on interstate commerce were not 'clearly excessive in relation to the putative local benefits.'"
Where Reform Stands in Virginia
Current State: No Meaningful Reform
Despite numerous attempts, Virginia's COPN law remains largely intact. Bills to repeal or significantly reform the law have consistently failed in the General Assembly, often due to strong opposition from the hospital lobby.
- ✗ CON program since 1973
- ✗ 19 services regulated
- ✗ Score: 100/100 (Most Restrictive)
- ✗ Repeal efforts have failed
States That Reformed
States that have repealed their CON laws have seen increases in healthcare availability, particularly in rural areas, and lower costs. For example, after repealing its CON law, New Hampshire saw a significant increase in the number of ambulatory surgery centers.
- ✓ 15 states have no CON law
- ✓ Increased competition
- ✓ Lower healthcare costs
- ✓ Improved access to care
The Rojas Report Take
Virginia's Certificate of Public Need (COPN) program is a classic example of a government-sanctioned cartel. Since 1973, it has served to protect established hospital systems from competition, driving up costs and limiting access for patients. The state regulates a staggering 19 services, far more than the national average, creating a bureaucratic minefield for anyone attempting to offer new healthcare options.
Look at the market concentration. In Northern Virginia, Inova Health System acts as a regional powerhouse, while Sentara Health dominates the Hampton Roads area. These systems don't have to compete on price or quality because the state's COPN law ensures no new players can threaten their dominance. When a physician can't even buy a second MRI machine to serve his patients because the state denies his application, it's clear the system is not designed for the public's benefit.
This isn't a free market; it's a protection racket. With a score of 100, Virginia's laws are highly restrictive, creating an environment where incumbents thrive and patients pay the price. The argument that these laws ensure quality or control costs is a smokescreen for the real purpose: protecting the profits of the hospital lobby.
Data sourced from the Virginia Department of Health, Centers for Medicare & Medicaid Services (CMS), Mercatus Center, and the Institute for Justice.