Proponents of Certificate of Need (CON) argue that it helps preserve health care infrastructure, especially in rural areas. They contend, for example, that repealing the law could lead to a greater concentration of ambulatory surgery centers (ASCs) in more urbanized areas, which would lead to rural patients traveling there for treatment and put community hospitals at risk.

But to the extent that market forces can operate under CON, patients are already migrating to access ambulatory surgical care outside of their counties of residence. While CON is supposed to effectively allocate health care resources across different geographic areas within North Carolina, the graph below illustrates a different story:

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