Health care in Nevada has a strange rule.
In some parts of the state, if a doctor wants to open a clinic, they have to ask the government for permission first. Even stranger, the doctor’s potential competitors can show up and argue against it.
That rule is called a Certificate of Need, or CON law. And it’s one of the reasons some communities struggle to get new health care services.
The idea behind the law sounds reasonable at first.
The government reviews proposals for new hospitals or medical facilities and decides whether the community actually “needs” them.
But here’s the problem.
When government decides who’s allowed to open a business, competition slows down. And when competition slows down, prices usually go up and choices go down.
That’s exactly why many states have started rolling these laws back.
According to the Committee to Unleash Prosperity, CON laws often act like a monopoly protection system for existing hospitals. Instead of encouraging innovation, they make it harder for new providers to enter the market.
Think of it like this.
Imagine if a new grocery store wanted to open in your neighborhood. But first it had to ask existing grocery stores if they thought the community needed another one.
How often do you think they’d say yes? That’s essentially how CON laws work in many states.
Nevada’s Halfway Fix
Nevada has already taken a step toward reform.
Today, Clark County and Washoe County are exempt from CON requirements. That means in Las Vegas and Reno, doctors and entrepreneurs can open clinics without going through the state’s approval process.
That covers about 90 percent of Nevada’s population.
State lawmakers made that change because they recognized something simple. In large cities, competition works. When more providers enter the market, services expand faster and costs often stay lower.
But rural Nevada still operates under the old system.
In counties with fewer than 100,000 residents, a new medical facility must still go through the CON process. That includes a $9,500 non-refundable application fee, public hearings, and a government review that can take 75 to 90 days.
During that process, existing providers can intervene and argue that the new facility isn’t necessary.
Supporters of the rule say it protects small rural hospitals. They worry that new clinics could open and take the most profitable services, leaving rural hospitals struggling to keep emergency rooms open.
That concern is real. But the current system isn’t the best solution either.
A Better Way Forward
Nevada doesn’t have to choose between a free market and rural health care. We can do both.
One option would be to remove CON requirements for many outpatient services. That includes urgent care clinics, imaging centers, and ambulatory surgery centers.
Those facilities provide routine procedures that don’t require a full hospital.
Allowing them to open freely would increase competition and lower prices for patients.
At the same time, the state could keep limited protections for rural emergency services. That might include requiring new providers to contribute to local emergency care or treat a share of Medicaid patients.
In other words, instead of blocking new clinics, Nevada could simply require them to help support the community.
Another reform would help fast-growing counties.
Right now the exemption threshold is 100,000 residents. As counties like Lyon and Nye grow, the law could automatically phase out CON rules once the population reaches certain levels.
That would allow markets to develop naturally as communities expand.
Why This Matters to Patients
Most people never hear about Certificate of Need laws. But they feel the effects.
Longer drives for medical care. Fewer choices. Higher prices.
Nevada has already recognized the benefits of competition in Las Vegas and Reno. Now it’s time to finish the job.
Health care should serve patients first. Not government gatekeepers.
The opinions expressed by contributors are their own and do not necessarily represent the views of Nevada News & Views. Digital technology was used in the research, writing, and production of this article. Please verify information and consult additional sources as needed.
