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Mitchell

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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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