The CON Game: Certificate of Need Laws Hurt Ga. Healthcare Costs, Choice

In Georgia, the healthcare spending difference because of CON equates to an additional $187 per person.”

— Matt Bolch

ATLANTA, GEORGIA, UNITED STATES, May 25, 2021 / — By Matt Bolch, Investigative Journalist for the Georgia Public Policy Foundation

Physicians Hugo Ribot Jr. and Malcolm Barfield fought Georgia’s certificate of need law all the way to the state Supreme Court, but the CON won.

“Basically, the Supreme Court punted,” Ribot, co-owner of The Georgia Advanced Surgery Center for Women, says of the 2017 decision.

“From what I could tell from their comments — because we attended [the hearing] — they politically punted and said this was a matter the Legislature should decide. I thought it was a weaselly avoidance of something we thought was constitutionally valid.”

Their battle began in 2015, when the ambulatory surgery center (ASC) applied for a certificate of need to add a second operating room and allow OB/GYNs from other practices to operate there. Three months after the state denied the CON, and supported by the Goldwater Institute free-market advocacy group, the physicians sued the state then appealed the subsequent denial to the state Supreme Court.

Georgia’s CON law requires providers “to obtain permission before they open or expand their practices or purchase certain devices or new technologies. Applicants must prove that the community ‘needs’ the new or expanded service, and existing providers are invited to challenge would-be competitors’ applications.”

Other providers can object to a hospital expansion, a new home health agency, new CT scanners or nearly two dozen other categories of healthcare services — and they nearly always do. This delays projects and creates mounds of paperwork and hefty attorney fees. In 2019, the Legislature mandated a 35-mile radius in which where providers can object, but lawmakers continue to ignore the higher healthcare costs in states with CON laws versus those without. In Georgia, the healthcare spending difference equates to an additional $187 per person, with 45% of that being direct physician costs.

“Sadly, it wasn’t a question about quality of care, which is higher, or infection rates and costs, both of which are drastically lower,” Ribot says of their denied expansion. “It’s all about lobbying and who’s the strongest lobby, which of course are hospital lobbyists.”

Simply put, Georgians pay more for healthcare, receive lower-quality care, and are denied freedom of choice because of CON regulations.


About the Georgia Policy Investigative Journalism Initiative: News coverage of the issues that matter to Georgians was shrinking before COVID-19, a trend exacerbated by the pandemic. As news staff and newspaper pages began to shrink once more, the Georgia Public Policy Foundation decided to seize the opportunity to get the news to Georgians: to write the articles ourselves. These investigative articles are provided at no charge to the media, published on the Foundation website at, and distributed via social media.

Suggest investigative articles at; sign up here for more articles like this.

Established in 1991, the Georgia Public Policy Foundation is a trusted, independent resource for voters and elected officials. The Foundation provides actionable solutions to real-life problems by bringing people together. Nothing written here is to be construed as necessarily reflecting the views of the Georgia Public Policy Foundation or as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature.

© Georgia Public Policy Foundation (May 25, 2021). Permission to reprint in whole or in part is hereby granted.

Keara Vickers
Georgia Public Policy Foundation
+1 404-265-4050
email us here
Visit us on social media:

Leave a Reply

Your email address will not be published. Required fields are marked *