Becker: Time for ending Certificate of Need and let health care meet the needs of Alaskans



Years of conversation about high prices and spending on health care in Alaska have produced many suggestions, but few have been acted upon. One solution that lawmakers are now considering is repealing Alaska’s Certificate of Need (CON) laws, which distort health care services and demand in Alaskan communities. As Alaskans with over 60 years combined experience in health care, we have been watching these developments with great interest. 

The federal government originally mandated CON laws for all 50 states in 1974 but backtracked by 1987. Such laws require health care practitioners to prove to state bureaucrats that building a desired facility, expanding an existing facility, or deploying new equipment is necessary for a community. The process is lengthy and expensive, and it prevents providers from responding to the needs of their patients in real time. At least 15 other states have almost completely repealed these outdated laws — why is Alaska clinging to them? 

The federal government initially mandated CON laws with the intention of decreasing health care costs, but dozens of studies have found their effect to be the opposite. In 2017, economists found that repealing CON laws would save Alaskans $294 in health care costs per person every year, so the annual savings could be in the thousands for families. That per capita average has surely increased by 2022. 

Additionally, repealing Alaska’s CON laws would give health care providers more flexibility to respond to the current needs in their communities and secure for Alaskans greater access to better-quality care. To respond to the COVID-19 pandemic, Alaska, along with 24 other states, temporarily halted some CON laws. Patients should have the same opportunity for responsive care all of the time. Global pandemics aren’t the only change to which providers must be able to adjust.

Other previously suggested reforms could help roll back government control of our health care and allow a better understanding of Alaska’s high costs, such as direct care and an all-payer claims database (APCD). Direct care removes unnecessary government control of health care and puts patients in a direct relationship with the doctor of their choosing. Protecting direct care in Alaska would give patients more health care choices that are affordable and high quality. 

An APCD could improve care and lower costs by giving Alaskans more-comprehensive data about health care prices, spending, and quality around the state. The caveat, however, is that any such database must not become merely a new financial burden on the state budget.

For too long, our communities have been bearing the burden of government control of health care, with higher prices and lower-quality care. Alaskans deserve affordable, quality health care, without the heavy hand of government interfering. This is the year Alaska should stop just talking about the high cost of health care and do something about it: repeal CON laws, protect direct care, and make necessary care more affordable.

Stephen Becker M.D., Ketchikan – Dr. Becker is an orthopedic surgeon with over 34 years in practice. Leslie Becker, Ketchikan – Mrs. Becker has 30+ years’ experience as a healthcare executive with working with large hospital systems.


  1. Thank you, Steve and Leslie. Alaska’s CON laws have severally restrained helath care in Alaska. Repealing the CON will result in lower costs, better care and most importantly get the state government out of health care business where it should NOT be.

  2. CON laws throughout the country have consistently resulted in higher costs and worse health outcomes for patients. They are only promoted by healthcare bureaucrats, industry lobbyists and their big health clients like Prov and Regional who seek to protect their near monopolies.

    The effort to the sunset CON laws here in Alaska is the most significant and important legislative initiative that has been produced in a decade.

  3. To expect the legislature to debate the facts and then do the right thing may be a hope to far but maybe this time something good will come and the result will bring an end to a program that should have never been in the first place…

  4. Not convinced. Government funded entities, have less economic risk for building and/or expanding, yet yield the highest cost to patients. The only way to stop this would be to keep all government entities receiving government funding accountable to CON. Government funded entities include hospitals and their surrounding medical services centers (Imaging, Urgent Care, Behavior Health, Lab and Infusion services). Not sure? Take a look at the government supported Heathcare entities with Class A commercial buildings that glisten with steel, granite, glass and dollars. These are on top of the medical food chain. It simply is not a level playing field without CON. CON measures have kept government funded entities costs to patients at bay, (without CON the private sector can simply not compete), even though health care costs have risen. The removal of CON measures, would remove the only competition, the private sector. Enter government funded monopolies.

  5. Stephen and Leslie- Welcome to your first steps in the Libertarian pathway. Your article clearly described a failed big government initiative; one of many that erodes our Liberty and Freedom on a daily basis. Be Brave. Don’t settle for the lesser of two evils.

  6. Stephen and Leslie- Thank you for clearly describing a failed big gov initiative like many others that negatively affect each of us daily. This is a great example of govt protectionism of a special interest. Neither old party desires to lose similar controls ensuring their special interests are taken care of. Not wasting another vote on either party this time around. 3rd party all the way.

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