Governor Charlie Crist has proposed repealing the Certificate of Need ("CON") process for acute care hospitals and replacing it with a licensing process, "to increase competition and efficiency in the healthcare marketplace and provide Floridians with greater access to quality services." The Governor made the proposal as part of his budget recommendation for fiscal year 2008-2009. A spokesman at Florida's Agency for Health Care Administration noted that a bill seeking the repeal of the CON process will likely be considered during the next legislative session.

Florida Hospital Association spokesman, Rich Rasmussen, said that the hospital community "unanimously opposes" the proposal, believing that the "move would create a two-tiered hospital delivery system in our state and cut a hole in the safety net." Texas has already eliminated the CON process for new hospitals. It has seen a big jump in the number of limited service hospitals that do not offer emergency services but reportedly focus on profitable services that are covered by commercial health insurance.

While approximately 36 states retain some type of CON program, law, or agency, according to the National Conference of State Legislatures, both the Federal Trade Commission and the Department of Justice have indicated that, on balance, CON programs are not successful in containing healthcare costs, and that they pose serious anticompetitive risks that usually outweigh their purported economic benefits. States that have retained CON programs tend to concentrate activities on outpatient facilities and long-term care facilities. The availability of quality care and safety net services likely can be better assured through minimum hospital service and charity care requirements