Montana’s Repeal of CON Laws Proves Competition Expands Access to Care

Four years ago, Montana legislators took a bold step: they eliminated nearly all of their certificate of need (CON) laws. Now, the results are in. Access to health care is expanding, new facilities are opening, and providers are serving more communities—all without the need for new government spending. 

According to a new report from the Frontier Institute, Montana’s health care market has seen positive growth since the state legislature passed HB 231 to repeal nearly all the state’s CON laws in October 2021. Health care providers were finally given the freedom to open or expand their businesses without asking bureaucrats for permission.in October 2021. Health care providers were finally given the freedom to open or expand their businesses without asking bureaucrats for permission. 

Since then, the number of outpatient surgery centers, home health agencies, and inpatient addiction treatment centers grew by 12.5 percent, reversing years of stagnant growth. Within a year, home health companies expanded into at least 18 additional counties. The long-term decline in addiction treatment providers stopped and began to recover. These results required no new tax dollars, only the freedom for entrepreneurs to compete for patients with better and cheaper care.  

By removing Montana’s CON restrictions, policymakers enabled providers to respond directly to patient demand. Rather than waiting months or even years for government approval, new facilities could open where and when communities needed them. This approach proves that competition and choice — not government control — deliver better health care outcomes.  

Montana’s experience is not unique. Other states have seen similar results. South Carolina repealed most of its CON laws in 2023, resulting in a rising number of inpatient and outpatient facilities being constructed. The removal of CON requirements in the state allows new competitors to enter the market more easily, resulting in greater potential innovation, reduced costs, higher quality care, and expanded service. 

Until a few years ago, Montana required health care providers to obtain government approval before opening or expanding medical facilities and services. CON laws forced providers to prove that their services are “needed” and even empowered incumbent providers to oppose new competition. 

CON laws originated in the 1970s when policymakers feared that an oversupply of health care facilities and services would drive costs higher. Decades of research have shown this is not the case.  

A growing body of data shows that states enforcing CON laws have fewer health care facilities, higher total health care costs, and worse quality outcomes, including higher mortality rates for common conditions. Federal antitrust officials have reached similar conclusions, finding that CON laws restrict entry, limit competition, and discourage innovation. The Department of Justice has likewise found that these regulations undermine market efficiency and raise costs, concluding that CON’s anticompetitive effects generally outweigh any supposed benefits. 

Across the country, CON laws continue to block billions in private investment in new care. Americans for Prosperity Foundation found $4.2 billion in health care investment was denied in North Carolina from 2012 to 2025, while $1.4 billion was denied in Tennessee from 2000 to 2023. These denials led to longer wait times, higher prices, and fewer choices— especially for patients in rural and underserved areas.  

CON reform is not a partisan issue. Every presidential administration since 1987, from conservative Reagan to progressive Biden, has urged states to roll back CON laws, recognizing the regulations suppress competition and choice. Federal officials have explicitly criticized CON as a barrier to entry that harms patients. 

The momentum for repeal is growing. Following the success of Montana, a growing faction of states are repealing and heavily reforming their CON regulations. Wyoming, Georgia, and Arkansas, among others, have taken action to roll back integral sections of their CON laws. 

Patients across the nation are suffering from artificial scarcity in health care. Montana’s success demonstrates that regulatory relief expands access and lowers costs. By eliminating CON laws, the state empowered providers to better serve their communities. Montana’s reforms should serve as a blueprint for other states seeking to make care more accessible, affordable, and responsive to patient needs. 

Nicholas Huff is a policy intern at Americans for Prosperity.