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Mitchell
5
Table 2. CON Fees by State (2023). State
Formula, if applicable
Minimum
Maximum
Alabama
$3500 $2500
$12 000 $75 000 No limit
Alaska
Arizona Arkansas
$200 per ambulance
$100
$3000
$3000
Connecticut
$500 $100
$500
Delaware
$10 000 $50 000 $50 000 No limit $100 000
Florida Georgia Hawaii Illinois Indiana
$10 000
$1000
$200 + 0.1% of first $1 m cost + 0.05% of costs in excess of $1 m
$200
$2500 $5000
$5000
Iowa
$600
$21 000 $25 000
Kentucky Louisiana
$1000
$200
$200
Maine
0.1% of capital costs
$5000 No fee
$250 000 No fee No limit $18 000 No fee $25,000 No limit No limit
Maryland
Massachusetts
0.2% of project cost
$500
Michigan Minnesota Mississippi Missouri Montana Nebraska
$3000 No fee
$500
0.1% of project cost 0.3% of capital cost
$1000
$500
$1000 $9500
$1000 $9500
Nevada
$7,500 + 0.25% of project cost for projects in excess of $1 m
New Jersey New York
No minimum
No limit
$500
$3000
North Carolina
$5000 $5000 $1000 $5000
$50 000 No limit $10 000 $90 900 No limit
Ohio
1.5% of capital cost
Oklahoma
Oregon
$500 + 0.25% of capital cost or $10,000 + 0.25% of capital cost
Rhode Island South Carolina
$500 $500
$500
Tennessee Vermont
0.575% of project cost 0.125% of project cost
$15 000
$95 000 $20 000
$250
Virginia
Unknown
Unknown
Washington
$770
$46 253
Washington, D.C.
3% of project cost
No minimum $300000
West Virginia
$1500 $1850
$35 000 $37 000
Wisconsin
0.37% of project cost, with $1850 minimum
Source. Cavanaugh et al. 29
extent that CON regulation is effective in reducing net investment in the industry, the economic effect is to shift the supply curve of the affected service back to the left. . .. The effect of such supply shifts is to raise. . .[the] equilibrium price” (p. 783). Given the anticompetitive features of the regulation, it may also give providers some degree of pricing power, 38,39 insulate them from the incentive to contain costs, 40 and encourage wasteful efforts to seek and maintain ing the privilege. 41 All these features suggest that CON is more likely to increase than decrease health care spending per service. And, in fact, that is just what the evidence shows.
since doing so will encourage the rejection of CON applica tions from would-be competitors.
The Economics of CON Were state and federal lawmakers correct to think that CON laws would reduce spending, increase access, improve qual ity, and ensure care for underserved populations? Neither economic theory nor decades of empirical evidence offer much support for these claims. First consider spending. As economists Ford and Kaserman 37 put it in 1993, “To the
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