In May 2023, South Carolina repealed most of its longstanding Certificate of Need (CON) law – a policy that once required healthcare providers to get state approval before opening new facilities or expanding services.
At the time, critics argued CON protected monopolies and blocked innovation. Supporters claimed it controlled costs and prevented duplication. Now, over a year later, the question is: What’s actually changed?
Outpatient Growth Is Happening – Especially in High-Demand Areas
Since the repeal, we’ve seen a noticeable uptick in new outpatient and urgent care centers, particularly in growing counties like Greenville, Horry, Lexington, and Charleston.
For example:
- Lexington Medical Center has announced a new outpatient center in Chapin.
- Atrium Health has opened or announced multiple freestanding ERs and urgent care centers across the Upstate.
- Private physician groups are beginning to expand into previously saturated areas now that CON no longer blocks access.
The pattern is clear: In places where population growth is surging, new facilities are moving in to meet demand – often faster and cheaper than traditional hospitals can.
It’s Still Early – But Competition Is Returning
The full repeal of CON for hospital construction doesn’t take effect until January 1, 2027. Until then, we’re mostly seeing changes in ambulatory care, diagnostic services, and physician practices.
That said, competition is already re-emerging:
- Independent providers no longer need permission from dominant systems to open or expand.
- In some counties, hospital-owned urgent care centers are now seeing direct competition from private groups with lower overhead and shorter wait times.
- Several rural counties are evaluating how to re-attract services that had been lost during the era of centralized control.
This is exactly what policymakers hoped would happen: More choices. Lower costs. Greater access.
But One Repeal Doesn’t Break the Monopoly
There’s a caveat – and it’s important.
Repealing CON doesn’t automatically level the playing field. If independent physicians are still blocked from practicing where they want (due to non-competes), or if hospital systems can undercut competitors using taxpayer-backed expansion, the effect of repeal will be muted.
We’re already seeing signs that larger systems are doubling down on scale to protect market share – building new facilities with borrowed dollars and federal subsidies while acquiring physician groups and clinics.
Decentralization takes more than policy change. It takes enforcement, accountability, and physician freedom.
The 2027 Deadline Is Coming – and So Is a Choice
South Carolina has a rare opportunity. In 2027, when the hospital construction provisions of CON are fully repealed, we’ll face a decision: Do we allow open competition to flourish – or do we watch a few major players dominate the system once again?
The early indicators are promising. But if we want a healthcare system that’s resilient, affordable, and accessible, we can’t stop at repeal. We have to clear the path for real competition – and protect the people and practices willing to show up and serve.
If you care about the future of healthcare- and of course you do- now is the time to pay attention. The coming months will be packed with insights, updates, and policy conversations that affect all of us.
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