The federal election overshadowed state matters in media coverage throughout 2024, but many healthcare laws differ between individual states. Legislative decisions occurred at that level too, so which states gained ground last year, and which took steps backward?
Winners
North Carolina saw hope for improvements in healthcare freedom during the year, although it still faces an uphill climb. Certificate of need (CON) laws, which allow powerful medical facilities to shut new practitioners out of the market based on supposed lack of need for their services, still operate there despite years of court battles and a declaration of unconstitutionality in 1973. With CON restrictions on all six healthcare practice categories, near-monopolies still flourish at the expense of both prospective practitioners and patients. However, the state’s Supreme Court recently agreed to resurrect the issue of CON constitutionality, after also relaxing some of its restrictions. Maybe 2025 will be the year healthy healthcare competition returns.
Georgia also made strides in CON legislation, after Republican Gov. Brian Kemp increased exemptions to anti-competitive rules. Psychiatric institutions, substance abuse recovery centers, perinatal and birthing centers, and rural hospitals can now open or expand—even if their competitors claim they are not necessary. Patients in need of any of these services now face less travel, waiting time, and financial worry.
South Carolina increased telehealth access in 2024, making permanent the types of improvements many states temporarily enacted during the COVID pandemic. Other practitioners can now use telehealth with the same freedom physicians can, meaning patients can continue to conduct appointments with these medical professionals from the comfort of their homes. Practitioners licensed in other states can also continue to practice telehealth for South Carolina patients, without having to jump through the hoops required for a local license. These laws enable patients to keep their chosen practitioners, allowing for care continuity and lower costs.
Needs Improvement
Kentucky continued its ongoing debate on CON, but failed—yet again—to seize the opportunity to overturn it. Despite tireless years of arguments from reversal advocates, the legislature still insisted such a step was too much, too soon. Republican Sen. Shelley Funke Frommeyer used an innovative approach to try again, bringing her colleagues on a field trip to an out-of-state birthing center to show what Kentucky was missing by blocking such facilities. Hopefully, such efforts will eventually prompt other lawmakers to budge on the issue.
Biggest Loser
California enacted a cornucopia of counterproductive measures in 2024, most notably by extending Medi-Cal, the state’s tax-funded health insurance, to all illegal immigrants. Far from helping any residents, legal or otherwise, this is destroying the system for all of them.
A third of Californians now receive this coverage, and as Margaret Thatcher famously said, “The problem with socialism is that you eventually run out of other people’s money.” This general principle was compounded by a staggering accounting error in 2022, which will result in a $165 billion shortfall over four years, instead of the surplus Gov. Gavin Newsom promised. Counting the eggs before they hatched, Newsom continued spending non-existent money on programs such as the Medi-Cal expansion.
But the problem got far worse. Insurance coverage does not magically create medical care, resulting instead in staffing shortages that prevent any patients from accessing providers. In an effort to increase employment in the medical field, the state increased minimum wage for healthcare workers. But again, no money existed to pay for the bump in payments, worsening the debt crisis. The Golden State budget is descending into chaos, and its healthcare system is collapsing.
National Summary
As usual, the year saw triumphs and failures. States trending toward free market solutions expanded access and lowered costs; states orchestrating government “solutions” envisioned by central planners experienced the opposite. During 2025, the consequences will continue to play out, and residents of restrictive states will probably continue to flee to those with medical freedom.