Are They Creating Monopoly‑Like Conditions in Kentucky Healthcare?
By Adam Brown 1-30-26
Access to timely medical care is one of the most important issues facing Kentucky families today especially in rural communities. Yet many people don’t realize how heavily the healthcare system is shaped by something called the Certificate of Need (C.O.N.) process. Kentucky is one of two states that still rely on this system for ambulance services, and its impact reaches from hospital expansions all the way to ambulance availability.
What Is a Certificate of Need?
A Certificate of Need, or C.O.N., is a state required approval that healthcare providers must obtain before they can open a new facility, expand services, increase bed capacity, or purchase major medical equipment. According to KY.gov, the goal of C.O.N. laws is to prevent excess growth and keep healthcare costs from rising by limiting unnecessary duplication of services and equipment.
In other words, before a hospital, clinic, or ambulance service can expand or even begin operating it must first receive permission from the state.
How CON Works in Practice
Kentucky law (KRS 216B.061) makes it clear that no person or organization may:
- Establish a new healthcare facility
- Spend above a regulated capital threshold
- Add or reduce certain numbers of hospital beds
- Make substantial changes to healthcare services
- Acquire major medical equipment
All of these actions require a Certificate of Need, and the application alone is lengthy and highly detailed. For example, any new ground ambulance provider must complete a complex, multi‑page submission simply to be considered. This raises the question: if we required this level of permission for businesses like restaurants, grocery stores, or gas stations, how much competition would survive?
Does CON Limit Competition?
Supporters of CON laws argue that restricting rapid growth prevents wasteful spending and protects existing providers especially in rural areas from being destabilized.
However, many Kentuckians believe the opposite has occurred. When only one or two organizations are allowed to operate in a region, the result can look and feel very similar to a monopoly a system in which a single entity controls a market and consumers have few, if any, alternatives.
In a true free market, more competition often leads to better quality, lower prices, and more choices. But in healthcare, competition is restricted by regulation long before it has a chance to begin.
The Impact on Ambulance Services
Perhaps the most visible consequence is in emergency medical services. Kentucky is one of only two states that still regulate ambulance services through the C.O.N. process. With limited authorization for new providers, many communities are left with only one available service or none within a reasonable distance.
Across the state, some residents report severe ambulance wait times, sometimes stretching for hours. In emergencies, these delays can have life‑or‑death consequences.
If more providers were allowed to enter the market without barriers, would response times improve? Many Kentuckians think so.
A System That Resembles Monopoly Conditions
The federal government recognized more than a century ago that monopolies harm the public. The Sherman Antitrust Act of 1890, followed by the Clayton Act of 1914 and the creation of the Federal Trade Commission, was designed to prevent any one company from controlling an entire industry.
Yet in healthcare, decades old C.O.N. laws continue to limit competition in ways other industries are not allowed to. When a single company or a tightly regulated few control ambulance services, equipment availability, and healthcare expansion, the similarities to monopoly like conditions become difficult to ignore.
Why This Matters to Every Kentuckian
Have you or someone you love ever waited hours for an ambulance?
Have you wondered why only one or two healthcare providers operate in your area?
These are not isolated issues—they are symptoms of a system designed to restrict growth, even when communities desperately need more options.
Healthcare should never feel like a monopoly. Families deserve choice, access, and competition that drives quality upward rather than limiting it from the start.
Join the Conversation
An upcoming public educational forum will be held soon in Powell County to discuss Certificates of Need, ambulance access, and how these issues affect every day Kentuckians. Bring your questions, your concerns, and your personal stories.
You can also join the discussion online by leaving a comment here on the Patriot website.
“A cheerful heart is good medicine, but a crushed spirit dries up the bones.”
—Proverbs 17:22
About the Author
I really never knew that Healthcare and emergency services were regulated to the point of a monopoly like situation. I heard someone mention that it was because of so much of the healthcare being paid for by Medicare and medicaid was part of the reason. I remember healthcare amd health inside being cheaper before it was made mandatory. Correct me if I am wrong but that is what I remember.