When Florida lawmakers voted in 2019 to stop requiring hospitals to get a certificate of need (CON) before opening or expanding, the state’s hospital industry was skeptical. The Florida Hospital Association’s then-president, Bruce Rueben, said that a “safeguard to access for hospital services has been removed,” adding that “over time, our state will learn whether this goal is accomplished and whether it was worthwhile.”
Five years of data are now available to assess how Florida’s health system has fared since its hospital CON law was repealed. So far, the signs are encouraging: Florida has gained hospitals, its patient ratings have held up better than the rest of the country’s, and more of its residents have a regular source of care.
More hospitals
Prior to repealing its CON law, Florida was losing hospitals. As Figure 1 shows, the number of community hospitals in the state fell from 220 in 2017 to 212 in 2019. Removing the CON review process was intended to make it easier for new hospitals to open, and in the years that followed, the trend reversed. By 2024, Florida had 229 hospitals, a net gain of 17 hospitals, or 8 percent. Florida bucked the national trend: over the same period, the rest of the country lost 37 hospitals.
Most of Florida’s hospital gains came in 2023 and 2024, which is what one would expect; planning, financing, and building a hospital takes time, so the effects of removing administrative red tape usually aren’t immediate. The pattern matches research on earlier repeals. In a 2025 study in the Southern Economic Journal, my coauthors and I found that repealing CON laws leads to a substantial increase in the number of hospitals in both rural and urban areas, beginning about 3-6 years after the reform.
Patient ratings held up
Opponents of CON repeal often warn that allowing new facilities to open will spread patients too thin and weaken quality. One way to assess this claim is to look at surveys of hospital patients. Figure 2 tracks the share of patients who rated their hospital 9 or 10 out of 10 (i.e., “excellent”).
From 2017 to 2019, Florida hospitals trailed the rest of the country on this measure by about 3 percentage points. Patient ratings fell everywhere during the COVID-19 pandemic, but Florida’s have recovered faster than the rest of the country’s. By 2024, Florida’s rating was 69.0 percent, nearly back to its pre-pandemic level, compared with 70.2 percent in the rest of the country – shrinking the gap to 1.2 percentage points. Whatever else new competition has done, it has not produced the decline in quality that opponents warned about.
Improved access to care
More Floridians also report having a usual source of health care. In 2019, 72.0 percent of Florida adults had a personal health care provider, compared with 77.0 percent of adults in the rest of the country, a gap of 5 percentage points. By 2024, 82.3 percent of Florida adults had a personal provider, compared with 83.2 percent in the rest of the country, closing most of the gap.
This is exactly the kind of access that CON’s defenders said the program was meant to protect. But Florida’s experience suggests that access is better achieved by market competition than by government policies like CON that tilt the playing field in favor of incumbent providers.
These are descriptive comparisons, and many factors other than CON laws, including the pandemic and changes in insurance coverage, shape hospital supply, patient experience, and access to care. But all three measures point the same way, and they echo decades of research on the effects of CON laws. A 2025 review of 128 studies concluded that CON laws increase spending, reduce access to care, and undermine quality.
Many states still require hospitals to get permission from regulators before they can open or expand. Lawmakers in those states should take a close look at Florida.