Will Delaware deliver on its health care promise?

August 12, 2026

From the newsletter of Sen. Bryant Richardson

The following is taken from an essay by Stacie Beck, Ph.D. Senior Fellow, Caesar Rodney Institute; Retired Professor, University of Delaware

The state government has obtained a federal Rural Health Transformation Program (RHTP) grant to improve healthcare access in rural areas. Delaware’s plan focuses on a new medical school to expand the pipeline of physicians.

While this is well and good in the long run, the state committed to a policy that would improve health care access, cost and quality much sooner and at no taxpayer cost, as a condition of the grant: eliminating or reforming the Certificate of Public Review (CPR) program.

The Hidden Barrier to Healthcare Access: Delaware’s Certificate of Public Review

Under the Certificate of Public Review (CPR) program, Delaware’s version of a Certificate of Need (CON) law, applicants must establish that there is a need for additional healthcare capacity before a certificate is granted to build it.

This requirement was based on the mistaken idea that excess capacity raises prices. Instead, this program has proven to be a barrier to new entrants, thus protecting existing health care suppliers from competition. Reduced

competition leads to less access, higher costs, and potentially lower quality care.

The CPR application process is burdensome. Applicants are asked to provide extensive financial data, as well as anticipated impact on existing providers.

Applicants’ data will be made public, thereby possibly giving away their competitive advantage.

The CPR review is conducted by the Health Resources Board. The board members are appointed by the Governor and has included industry insiders.

Records of votes by members are incomplete or missing. This is a picture of a regulatory agency captured by industry insiders with the goal of limiting competition.

Why CPR Keeps Healthcare Providers Out of Delaware

The CPR application process is therefore risky. Applications can be denied on a wide range of factors.

Delaware’s CPR law doesn’t just delay healthcare expansion—it discourages many medical providers from investing in Delaware in the first place.

We, at CRI, have heard from health care providers. “We don’t want to come to Delaware because of the CPR law. It isn’t worth the investment to risk approval.”

Delaware Made a Promise. Now It Should Keep It.

The Delaware legislature, in its letter of support for the state’s RHTP grant application, committed to CPR reform. In particular:

‘Delaware commits to eliminating or loosening Certificate of Need laws (known as “Certificate of Public Review” inº DE) to reduce regulatory barriers for providers establishing new facilities in rural areas.

CRI supports full repeal of Delaware’s CPR law, as proposed in House Bill 318, sponsored by Representative Bryan Shupe.

Previous efforts to reform the CPR focused on improving how the CPR was administered, not on loosening the law’s effect on restricting competition.

Patients Can’t Wait

“I can’t get an appointment for months!” How often do we hear this? Delaware’s citizens are suffering from a lack of health care access now.

Of all the actions and programs listed in the state’s Rural Health Transformation Program (RHTP) grant narrative, eliminating the CPR requirement is the action most likely to expand health care access and lower costs now, when we need it most. It costs taxpayers nothing.

Delaware made this commitment to secure the RHTP grant. Let’s hope this finally gives the state government the incentive to honor that commitment by eliminating the Certificate of Public Review law once and for all in Delaware.

411 Legislative Ave, Dover, DE 19901

302-744-4298 Bryant.Richardson@delaware.gov