Site under construction. As a trio of states lower the CON barriers to building hospitals, others are studying a variety of reforms to promote competition.

CON reforms were approved in Florida, Georgia and Iowa this year, and other states are also looking at ways to promote competition. While some observers don't see a move to sweeping change, it's a trend that draws applause. "There's no plausible argument that certificate of need meets its intended purpose. Instead, it denies access and it denies choice," says consultant Robert James Cimasi, left!