New Study Shows North Carolina’s CON Law Blocked $3 billion in health care investment in 3 years
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| April 2, 2025
A new analysis by Americans for Prosperity Foundation (AFP Foundation) shows North Carolina’s certificate-of-need (CON) program denied $2.8 billion in proposed health care investment since January 2022.
The CON law requires health care providers to obtain approval from the Department of Health and Human Services before acquiring, replacing, or adding facilities, services, or equipment.
AFP Foundation originally published a report on the impact of North Carolina’s CON law in 2022. That study, which analyzed CON applications dating back to 2012, found that the CON regime denied nearly $1.5 billion in proposed capital expenditures over a 10.5 year period.
In this update, AFP Foundation finds that North Carolina has denied twice as much health care investment in the last three years than the previous decade.
| Year | Capital Expenditures Denied a CON |
| 2012-2021 | $1.4 billion |
| 2022-2025 | $2.8 billion |
However, the true value of health care investment foreclosed over the last 15 years is assuredly much greater than the $4 billion in capital expenditures on denied CON applications. The state’s CON law prevents many providers from ever applying to offer services they otherwise would.
North Carolina has the most expensive health care of any state. Interest in health care investment in the Tar Heel state is at an all-time high; however, the result of so much lost health care is that North Carolinians pay higher prices for less access and lower-quality health care.
