When it comes to cancer, time is the ultimate currency for both doctors and patients.
Yet here we are in the midst of another legislative debate on whether incumbent providers, primarily hospitals, should have a “competitor’s veto” over additional access to care – even for treating cancer.
In this instance, Senate Bill 367, sponsored by Sen. Bill Cowsert (R-Athens), would eliminate Georgia’s certificate of need (CON) requirement for all facilities, service lines and equipment dedicated to treating cancer. This legislation would rectify a regulatory system that forces patients to travel unnecessary distances for treatment, while their oncologists spend time and money filing applications and legal appeals.
Legislative debates over CON laws typically focus on questions of cost, access and quality. Defenders of the current system counter that a state without CON laws would lead to facilities “backed by private equity” which are able to care only for patients with commercial insurance.
They are particularly worried about this cherry-picking when it comes to highly reimbursed elective surgeries. But again, we are talking about cancer. There’s nothing elective about that.
Georgia’s CON laws are what remains of the federal government’s approach in the 1970s to curbing healthcare costs. Congressional action was required since federal reimbursement at this time was incentivizing unnecessary capital expenditures. By the mid-1980s, Congress realized this approach to restricting healthcare was flawed and repealed the federal law, but the resulting state laws remain on the books in 35 states.
In practice, CON laws have since become a shield for incumbent hospitals to block competition, stifling the very innovation that drives down costs and improves outcomes.
Consider the recent testimony before a Georgia Senate committee of Dr. Petros Nikolinakos, a medical oncologist and the president of University Cancer & Blood Center (UCBC) in Athens. UCBC has 25 doctors, 500 employees and 13,000 patients. But for years the practice was locked in a prolonged legal fight with Piedmont Athens over the acquisition of a PET scanner that would provide high-quality screenings.
With UCBC unable to meet its patients’ needs onsite, the only option for most of these patients was to have the necessary – and lucrative – imaging done at Piedmont Athens. Twice UCBC went through the state’s approval process for a new PET scanner; twice Piedmont Athens opposed the application.
Thankfully, in 2024 the state legislature eliminated the CON requirement for new imaging equipment at medical facilities. Once UCBC was able to purchase the PET scanner, patient wait times at UCBC dropped from weeks to days.
But that 2024 reform was narrow in scope. If UCBC sought to provide other vital services such as port placements for chemotherapy, onsite surgery for breast cancer or colorectal cancer, radiation oncology, or even biopsies just to determine whether cells are cancerous – all require another costly and prolonged fight through the CON process.
Legislators also heard from Dr. David Squires, a medical oncologist and the CEO of Augusta Oncology. After his practice submitted a CON application for a new cancer center because its existing facility was maxed out, both Doctors Hospital and Wellstar MCG (formerly Augusta University Medical Center) filed opposition to the new facility. Consequently, the state denied the application.
Fortunately for Augusta Oncology, South Carolina eliminated almost all of its CON laws around the same time that the Georgia Department of Community Health was in the process of denying their application. Without those same regulatory barriers on the other side of the Savannah River, the practice was able to open a comprehensive radiation and medical oncology practice under one roof in 2025 — in North Augusta, South Carolina.
Dr. Squires also shared that in addition to a more robust level of care all under one roof, his practice also offers services at a cheaper price because it doesn’t charge hospital facility fees.
Again, this means that Georgia’s regulations have been directly responsible for the expansion of healthcare in South Carolina.
According to the Georgia Board of Healthcare Workforce, in 2024 there were 578 total oncologists statewide. But 262 of these physicians – nearly half – practiced in either Fulton or DeKalb counties.
The dysfunction of CON laws extends beyond independent practices; even some of the state’s largest health systems are hitting a regulatory ceiling. Testimony from Emory Healthcare highlighted how its three linear accelerators (LINAC) used for radiation oncology at Winship Cancer Institute at Emory Midtown, have been above 100% utilization for the past two years, including a 155% utilization rate in April 2025.
When Georgians must cross state lines for cancer care or wait months for life-saving scans, the system has failed. By passing this legislation, the state can shift from prioritizing monopolies to prioritizing patients.