By Liam Siguad
If you’ve visited a Maryland emergency room lately, you’ve likely experienced it first-hand: The agonizing wait.
In 2024, a Maryland Hospital Association report revealed that Maryland has the longest emergency department wait times in the entire country. In a state that prides itself on world-class medical institutions, patients are left languishing in hallways for hours, sometimes days, waiting for a bed.
Long wait times in the emergency room are a sign of a deeper problem in Maryland’s healthcare system: Overwhelmed primary care providers can’t provide timely care to patients with preventable and non-urgent health conditions. When manageable problems are left unaddressed, people wind up in the emergency room.
Maryland needs more health care facilities and workers to meet the needs of an aging population and address persistent shortages of specific services, such as behavioral health and maternity care.
But a proposal pending before the General Assembly would make essential medical services less accessible and reduce investment in the healthcare system. Senate Bill 494, and its companion House Bill 944, seeks to expand a failed bureaucratic regime known as Certificate-of-Need (CON) laws — government red tape that requires health care providers to obtain permission from a state board before they can build a new facility, buy new equipment, or merge.
To understand why this bill is misguided, you have to understand the outdated system it props up. CON laws were introduced decades ago based on the theory that if the government restricted the supply of health care, costs would somehow go down.
But instead of driving down costs, CON laws have made it difficult for new providers to enter the market, strangling competition and allowing large incumbent hospitals to charge higher prices. The CON process is slow, uncertain, and costly. In many cases, the applicant’s direct competitors — a rival hospital, for example — intervene and lobby to block or delay the request for a CON. And they often succeed in derailing projects: In some states, nearly half of CON applications are rejected.
Economists have extensively studied the effects of CON laws on costs, access to care, and quality of services. Overwhelmingly, research finds that these regulations are bad for patients.
This isn’t controversial. The last seven presidents – regardless of their party affiliation – have opposed CON laws. Many states have acted to roll back their CON regulations, and more than a dozen states have dismantled their CON programs entirely. That includes several of Maryland’s neighbors; in recent years, West Virginia and Pennsylvania have loosened their CON regulations on birth centers and substance abuse programs, respectively.
Yet Maryland retains some of the most burdensome CON laws in the country, covering hospitals, surgery centers, nursing homes, home health agencies, rehabilitation facilities, and many other types of providers.
SB 494 and HB 944 don’t just keep these harmful laws in place — they make them worse by removing exemptions that currently allow mergers and consolidations to bypass the full CON review process. While the desire to prevent market concentration is laudable, the bill creates a new layer of bureaucracy by mandating that a wide range of transactions be subjected to a “public interest” review that includes vague criteria like “equity,” “access,” and “staffing.” These terms are open to broad interpretation, making the CON process even more unpredictable.
These changes would further entrench the government-run Maryland Health Care Commission as a central planning board disconnected from the needs of patients. A financially necessary merger might be blocked because it doesn’t meet an arbitrary definition of “equity,” forcing the struggling facility to close entirely rather than restructure.
Lawmakers in Annapolis should be laser-focused on tearing down the barriers that make care scarce and expensive.
Uncertainty deters investment and drives away health care innovators. Under this bill, private capital will simply bypass Maryland for states with more welcoming and predictable regulatory environments. As a result, Maryland providers will have fewer funds to upgrade technology, renovate facilities, or expand services. In the end, patients will pay the price.
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