  In many states, certificate-of-need (CON) laws prevent ambulatory surgical
centers (ASCs) from entering the market or expanding their services. This paper
estimates the causal effects of state ASC-CON law repeal on the accessibility
of medical services statewide, as well as for rural areas. Our findings show
that CON law repeals increase ASCs per capita by 44-47% statewide and 92-112%
in rural areas. Repealing ASC-CON laws causes a continuous increase in ASCs per
capita, an effect which levels off ten years after repeal. Contrary to the
'cream-skimming' hypothesis, we find no evidence that CON repeal is associated
with hospital closures in rural areas. Rather, some regression models show that
repeal is associated with fewer medical service reductions.
