Bringing a hospital to Wake Forest remains one of our community’s most important priorities. As our town and surrounding communities continue to grow, access to hospital-based emergency and acute care has become woefully and potentially dangerously scarce. For residents of northern Wake County and neighboring Franklin County, that can mean traveling significant distances for care when minutes matter most.
A hospital also represents an important piece of Wake Forest’s long-term economic development strategy. The Wake Forest Business & Technology Park is poised to become a major employment center for our community, bringing new investment, high-quality jobs, and expanded services to the area. A hospital campus has long been central to that vision and would create an economic impact that reaches well beyond the walls of the facility itself.
Unfortunately, efforts to bring a new acute-care hospital to Wake Forest have repeatedly encountered obstacles through North Carolina’s Certificate of Need process. That process, and what it means for a rapidly growing community like ours, has become an increasingly important conversation at both the local and state levels.
Throughout this effort, NC House Rep. Mike Schietzelt has been an invaluable and ardent advocate for Wake Forest and northern Wake County. Rep. Schietzelt understands both the urgency of improving access to healthcare in our region and the broader implications for our continued growth. His advocacy is bringing greater attention to the challenges we face, is significantly elevating the conversation in Raleigh, and remains an essential partner as we continue working toward a hospital for this community.
Rep. Schietzelt recently shared his perspective in an op-ed originally published by The News & Observer, outlining why he believes northern Wake County needs a hospital and how North Carolina’s Certificate of Need laws are affecting our ability to meet that need.
Because this issue is so important to the future of Wake Forest, Rep. Schietzelt has also given us permission to share his letter with our readers. I am deeply grateful for his continued advocacy for this community and his willingness to keep this important conversation as a top priority in the Legislature.
The perspective that follows is Rep. Schietzelt’s, and I hope you will take a few minutes to read his case for why Wake Forest and our northern neighbors should not have to wait any longer for greater access to hospital care.
Jason Cannon
President, Wake Forest Business & Industry Partnership
My growing community can’t get a hospital. It’s a dangerous racket
We need a hospital in northern Wake County.
The Wake Forest zip code has a population of about 90,000 people. That’s larger than sixty-seven counties in North Carolina. To the east, Rolesville adds another 10,000. Franklin County, to our north, adds approximately 83,000 more.
None of these jurisdictions has an emergency department. Franklin County is the largest North Carolina county without an acute-care hospital. Yet, despite the demonstrable need for hospital beds north of Raleigh, the NC Department of Health and Human Services (NCDHHS) denied an application to build a 50-bed ER in Wake Forest earlier this year. The agency denied a similar application the year before.
Why was the application for a much-needed emergency room denied? The answer lies in North Carolina’s Certificate of Need (CON) laws.
It works like this: NCDHHS projects healthcare needs based on population growth and utilization. That projection leads to an allocation — in this case, a number of acute-care beds that providers can add in a county. Providers must then apply for a slice of this allocation — a “Certificate of Need” that enables them to build these beds and facilities.
CON emerged in the 1970s as a federal mandate. The premise was that health care inflation was driven by providers artificially creating demand. The solution was to restrict supply. By the mid-1980s, the federal government had reversed course and urged states to repeal the very schemes it had required. Most have. North Carolina has not.
The results are what you would expect when you restrict supply in a market with growing demand. Prices rise. Access shrinks. Wait times get longer.
These are more than abstract statistical problems. They’re real-life experiences impacting our neighbors in northern Wake County. Ask our friend who had to drive down miles of country roads from the north to the heart of Raleigh when her five-year-old daughter suffered a life-threatening asthma attack. Or I could tell you about my father’s stroke in 2024 right as early morning rush hour began. In those moments, minutes feel like an eternity, a few miles can feel like a world away, and supply restrictions imposed by bureaucratic formulas aren’t just inconvenient — they can be deadly.
In a functioning market, high prices and limited access would create opportunities for new providers to meet demand. CON forecloses that. But what we learned in Wake Forest this year made clear that the system is even more rigged than most people realize.
With 267 beds available in Wake County this year, a rapidly growing population, and no hospital at all in Franklin County, many of us expected our region to finally see some relief. We were wrong.
NCDHHS explicitly stated that it preferred expanding existing hospital campuses over allowing new hospitals to enter the market. New market participants are frozen out. New geographic markets are deprioritized.
DHHS awarded every single one of the 267 Wake County beds to existing hospitals in Raleigh. WakeMed Raleigh received 164 beds. UNC Health Rex received 51. Duke Raleigh received 52.
Northern Wake County, with some of the fastest-growing suburbs in the state, still has the same number of acute-care beds it had decades ago — when its population was less than a tenth of what it is today.
Now add hospital consolidation into the equation. In May, WakeMed — which just received 164 of those 267 beds — announced plans to merge with Atrium Health, North Carolina’s largest health system. The same regulatory structure that denied northern Wake County a hospital while protecting legacy Raleigh campuses will now shield an even larger consolidated system from any competitive response.
Numerous studies have associated hospital consolidation with higher prices, lower quality, and reduced access to care. And yet, consolidations proceed with far less regulatory scrutiny than the simple expansion of supply.
Certificate of Need is a one-way anti-competitive ratchet, and consolidation tightens it further. It creates near-monopoly conditions for existing providers and leaves growing communities without options. This is not a market. It is a regulatory structure that protects large hospitals at the expense of patients.
That facts couldn’t be clearer. Northern Wake County needs more acute-care beds — and we aren’t the only ones. Certificate of Need is inflating costs, blocking access, and hindering economic development in these affected areas.
It’s past time to eliminate Certificate of Need in NC — if not statewide, then certainly in growing areas like mine. We can’t afford to let government bureaucracy dictate the pace of growth, and our neighbors shouldn’t have to wait any longer for better access to emergency care.
Rep. Mike Schietzelt (R-Wake) represents northern Wake County in the N.C. General Assembly.
