Delegate Scot Heckert (center), R-Wood, asks questions during public testimony on House Bill 2007 in the House Health Committee on Feb. 20, 2025. The bill, as it was proposed, would have eliminated Certificate of Need laws in West Virginia.
Delegate Scot Heckert (center), R-Wood, asks questions during public testimony on House Bill 2007 in the House Health Committee on Feb. 20, 2025. The bill, as it was proposed, would have eliminated Certificate of Need laws in West Virginia.
As federal Medicaid reforms under “One Big Beautiful Bill†tighten the purse strings, West Virginia must take control of its health care future.
The bill will cut nearly $800 billion in federal Medicaid funding over 10 years and impose new work requirements, resulting in almost 8 million fewer Medicaid enrollees, according to the Congressional Budget Office. At the same time, Affordable Care Act subsidies are set to expire, potentially increasing premiums and affecting coverage. Together, these changes will tighten the safety net, leading to drastic shifts in the health care market.
With less federal support, West Virginia must act decisively to protect access to care and stretch health care dollars. A smart place to start: Repeal outdated certificate of need laws.
CON laws require health care providers to obtain state approval before opening or expanding facilities and services. Originally intended to prevent “wasteful duplication,†these laws have instead stifled competition and blocked the development of new, lower-cost outpatient alternatives. As a result, they drive up costs, limit patient choice and make our Medicaid dollars work less efficiently.
Research from the Cato Institute shows that repealing CON laws leads to a 44% to 47% increase in ambulatory surgical centers per capita, with rural areas seeing even more growth. These centers perform common procedures like colonoscopies and joint surgeries at a fraction of the cost of hospital-based care. For a state grappling with a tighter Medicaid budget, this shift represents a real opportunity to stretch resources without sacrificing quality.
By blocking new providers, CON laws shrink the supply of health care options, especially when facilities close. In rural communities, this means longer travel times and fewer choices for essential care. Repealing CON would remove these barriers and invite investment in new clinics, outpatient centers and telehealth services that bring care closer to home and reduce strain on existing facilities.
Proponents of the protectionist policy claim repealing CON will lead to hospital closures, but this fear overlooks reality: CON laws often protect inefficient providers that aren’t meeting community needs. Shielding these facilities from competition, and providing the authority to veto incoming applications, only delays the inevitable while blocking more agile providers from stepping in. As Medicaid funding will soon tighten, West Virginia will need a dynamic, responsive health care system rather than one frozen in place by outdated regulation.
We’re at a crossroads. Repealing CON aligns with the fiscal responsibility now demanded by federal reforms and empowers providers to innovate. It introduces more choice, expands access, and promotes smarter spending without compromising quality of care.
West Virginia doesn’t need more red tape. We need more care, more competition and more solutions. As the future of health care is reshaped, West Virginia must complement these changes with bold, smart reforms — starting with the repeal of CON — for a stronger, more resilient health care system.
Jessica Dobrinsky is the chief of staff at the Cardinal Institute for West Virginia Policy, a conservative think tank.
