Certificate of Need (CON) Resource Center

April 1, 2022

Palmetto Promise Team

This legacy webpage contains material published in support of the repeal of the South Carolina Certificate of Need (CON) statute. The General Assembly passed full repeal in 2023 as S.164 (sponsored by Senator Wes Climer). The Governor signed the legislation into law on May 16, 2023.

Oran Smith and Josh Archambault describe the Palmetto State repeal in this article for Forbes.

Here in one place are the reasons (and the supporting data) for why Certificate of Need needs to go.

This new study, prepared specifically for South Carolina, reviews all relevant peer-reviewed studies on the impact of Certificate of Need laws. There are also highlights from the South Carolina Legislative Audit Council report that showed how long CON drags out needed healthcare projects in our growing state due to the aggressive actions of competitors.

Neighboring States Taking Action

Florida Repeals Certificate of Need
June 2019. Florida removed the CON requirement for general hospitals, complex medical rehabilitation beds and tertiary hospital services.

Tennessee Makes Major Changes to CON Law
June 2021. The new Tennessee law, which became effective October 1, 2021, changes requirements for CON approval and streamlines the process slog.

South Carolina-Specific Research

 Fast Facts: SC’s Anti-Competitive Certificate of Need Laws
May 11, 2021. South Carolina’s CON program is one of the most restrictive in the United States. South Carolina requires a CON for 18 different services, including hospital renovations/new equipment that is over $600,000 and adding one or more hospital beds to a facility. Find out more top-line facts in this report.

South Carolina CON State Profile
2016. Mercatus Center breaks down the ways in which CON is costing patients in access and high costs for services. 

South Carolina’s Certificate-of-Need Program: Lessons from Research
May 2021. Mercatus Senior Research Fellow Matthew Mitchell’s testimony to the SC Senate Medical Affairs Committee, including up-to-date and pertinent research from Mercatus on South Carolina’s CON program.

Former Hospital Official Addresses CON
May 2021. H. Howell Clyborne Jr., a former SC lawmaker and hospital official, writes: “There might have been a time for Certificate of Need laws. But—and I feel my background qualifies me to say this—the time has come and gone.”

South Carolina Physicians Speak Out
May 2021. A Senate Medical Affairs subcommittee heard testimony from SC doctors on S.290, the bill to completely repeal South Carolina’s Certificate of Need (CON) laws.

Presidents Obama and Trump Agree: CON Must Go

President Obama’s Federal Trade Commission and President Trump’s Department of Health & Human Services each stated that CON laws hurt patients and should be repealed.

The Wrath of CON

The Case for CON Repeal in Four Minutes Flat

National Research

Conning the Competition: A Nationwide Survey of Certificate of Need Laws
August 2020. This is a still-current analysis of CON by the Institute for Justice (IJ) from a legal and policy perspective featuring a section on South Carolina.

Certificate of Need and Access to Healthcare
April 2021. This podcast features healthcare experts discussing CON laws and the dangerous restriction of care access it has caused since the outbreak of COVID-19.

How Can Certificate of Need Laws Be Reformed to Improve Access to Healthcare?
September 2021. A short book chapter on CON by two professors at Utah State University.

Permission to Care: How Certificate of Need Laws Harm Patients and Stifle Healthcare Innovation
October 2021. A policy analysis from Americans for Prosperity.

Econometric Research

Certificate-of-Need Laws and Healthcare Utilization During COVID-19 Pandemic
July 2020. A more in-depth scholarly treatment of the effects of CON from a team of economists.