A push for hospital consolidation emerged as some community members saw this as a failure of the local health care system, according to a history of St. Luke's written by Sue Cole.

Ultimately, St. Joseph emerged as the county's lone hospital, meaning that when they submit certificates of need now, there aren't any other hospitals to object or compete. I spent weeks looking into Washington's CON system and how Whatcom County's lone hospital operates within the state requirements.

The story examines critiques that say the regulation protects incumbent hospitals' market dominance. Given the pressing concerns over health care costs, Medicaid cuts, rising premiums and expiring subsidies, you might wonder why a decades-old regulation is relevant right now.

So long as Washington maintains its CON program, the regulation determines who can provide what care. Changes to the state's CON program have happened in the past and may come again, as the state legislature is considering modernization. There is an ongoing debate among researchers and economists over whether CON increases or reduces health care costs.

The other reason we should care is because there is ongoing litigation in other states brought by providers challenging the constitutionality of the state's CON programs. Locally, our only hospital is enduring an ongoing expansion that was only possible with CON approval.