Improving Access, Lowering Costs: Washington Shouldn’t Be Blocking More Healthcare Supply

The most recent episode of the Tradeoffs healthcare podcast covered “certificate of need” laws, which require providers to prove to state regulators that there is a market need before they can open new facilities. It’s worth a listen.

Washington is one of the 35 states (plus DC) that still have these laws on the books, though there has been legislation in recent years to grant exemptions for new psychiatric beds and to carve out one procedure at one state-run facility.

The 2024 supplemental operating budget also provided $500,000 to the WA Department of Health “to conduct an analysis of the certificate of need program .. and report its findings and recommendations for statutory updates to the governor and appropriate legislative committees by June 30, 2025.”

That report makes for interesting reading, especially alongside an early-process presentation developed by the same consultants who worked on the report.

So why, you might be asking, are we taking this deep detour into healthcare policy wonkery?

Well, you may have seen the story this week about the shadowy group working to block a WinCo Foods from opening a new location in an abandoned Sam’s Club building in North Seattle:

Two years ago, discount grocery chain WinCo filed plans to remodel the building and reconfigure the parking lot on Aurora Avenue North… [L]ast fall, a coalition called Lake Washington Working Families appealed the decision. The group, which tried and failed to disrupt plans for a WinCo coming to Renton last spring, has no website and is not registered with the state — leading to online speculation about who exactly is behind the group. But Karl Anuta, a Portland-based lawyer representing the coalition, said it’s made up of King County residents.

We don’t know who’s actually behind that group. We do know that big businesses have the legal and lobbying might to hack regulatory processes to block competition. That constrains supply, diminishing consumer choice and – frequently – leading to higher prices.

Certificate of Need (CN) laws provide much the same pathway, with existing providers able to participate in the process to try to block new competitors from opening. That’s likely one reason there’s little evidence supporting the idea that CN laws reduce healthcare costs (from the slide deck above):

And:

Healthcare economics are incredibly convoluted. I don’t want to suggest any of this is simple. But it is difficult to understand the mechanism DOH is envisioning here:

Especially in a part of the state where we see one of the most dramatic undersupplies of healthcare service availability:

For most of my adult life, when we have talked about healthcare policy in America, we have focused on the availability of insurance. But the reality in 2026 is that having access to insurance isn’t enough. We must get the cost side under control, before we bankrupt families and the state general fund.

That means taking a very hard look at centralized planning processes that delay new projects, block competition, and limit access to services, especially in rural communities.

I mentioned at the beginning that 15 states don’t have CN laws anymore. California and Texas are both on that list. When those two states agree on something, it’s worth a look for Washington.

[Photo by Jimmy Conover on Unsplash]