RALEIGH (July 17, 2025)—The John Locke Foundation’s William Allen discussed NC’s Certificate of Need (“CON”) program last night at a Wake County Libertarian Party meetup at Tobacco Road in downtown Raleigh.

Back in the 1970s, incentivized by a Federal mandate 49 states put CON programs in place, requiring health providers to obtain the permission of a state board before opening, expanding, or offering a new type of service, Mr. Allen explained. The idea was that centrally planning/managing the availability of health care services would result in better availability in relatively underserved rural areas.

By the early 80s, it was clear that CON laws were not materially increasing health care service availability in either rural or urban areas, and the Federal mandate was terminated. But by then, larger health services providers had learned that they could gain an advantage over smaller potential competitors in influencing the CON process and, and in most states, they lobbied to maintain the programs. While the programs have been rescinded in some places, today there are still 35 states that have active CON laws.

And among those, North Carolina’s CON program is the third most extensive.



“CON laws limit competition by requiring state approval, allowing existing providers to dominate the market and stifling new entrants,” stated Mr. Allen. “Reduced competition increases healthcare costs for patients and insurers. And fewer providers and limited facilities disproportionately affect rural and underserved communities…ironic given that one of the main arguments in favor of putting these programs in place 50 years ago was that they would help rural communities.”

Matthew Laszacs, 2024 Libertarian candidate for NC House 41 and the coordinator of WakeLP lobbying efforts on CON rescission, also addressed the audience. 

“North Carolina is facing an increasing shortage of healthcare services, both in rural areas and fast-growing urban regions. With the recent expansion of Medicaid, demand will only rise,” Mr. Laszacs stated. “Unfortunately, our current CON regime limits providers' ability to respond to this increased need. By requiring state approval before opening or expanding medical facilities, our CON program delays care, reduces competition, and blocks innovation. And, as William has demonstrated, studies from the states that have repealed their CON programs show that access to care has increased, particularly in underserved communities. Repealing CON laws in North Carolina would be a practical, evidence-based step toward improving healthcare access and outcomes for all residents.”

Party chair Brad Hessel added, “Our focus is on improving life right here in Wake county. Rescinding North Carolina’s CON program is an excellent example of something that would clearly do that.

“I find it telling that while. as William explained, the original intent of imposing a Certificate of Need rationing system was to improve the availability of healthcare services in rural North Carolina, but if you look at which Senators voted to repeal our CON law, most of them represent rural areas. One notable exception was Wake County’s own Dan Blue, one of only two Democrats in the Senate to vote for the bill, and we thank him for his support.

“We hope that when the NCGA comes back to complete the long session, the House will take up and pass this bill,” he concluded. 

Mr. Allen pointed out that the provision rescinding North Carolina’s CON program has recently been added to the Senate’s version of the budget, raising the possibility that it could be enacted as part of that legislation, with no need for it to be passed as a separate bill.

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For more information contact:
Brad Hessel, Acting Press Secretary
(919) 846-5227 
[email protected]

For more information about the John Locke Foundation, contact:
Brenée Goforth Swanzy
[email protected]