Fifty billion tied to policy change

The Trump administration is conditioning federal funding from the Rural Health Transformation Program on whether states end or loosen certificate of need laws that regulate hospital construction.

Six states signal compliance

Six states indicated plans to revisit their certificate of need laws in applications for the fifty billion dollar program.

What certificate of need laws do

Certificate of need laws require healthcare providers to prove community need before building new facilities or expanding services. More than thirty states plus Washington D.C. enforce some form of these laws.

The original intent

Certificate of need laws were intended to curb monopolies and rising healthcare costs. But critics say they have instead raised prices, stalled needed facilities, and barred rural patients from new technology.

Decades of scrutiny

Legislators in several states have pushed to end certificate of need laws for decades under both Republican and Democratic administrations. The Trump administration's approach to tie funding to policy has forced states to act quickly.

Tennessee leads the way

Tennessee passed a bipartisan bill in April that will unravel most of its remaining certificate of need rules over the next four years.

South Carolina's three-year delay

In North Carolina, a hospital that won certificate of need approval to build a much-needed facility was mired in a court battle for three years before breaking ground in twenty twenty-six.

Loss of transparency warning

Maureen Hensley-Quinn at the National Academy for State Health Policy warns that removing certificate of need laws will eliminate records that help states track hospital ownership and financial health of health systems.

“Without CON, without ownership reporting, and without an entity that monitors transactions or providers in that way, there's no way for you to know.”

Tennessee hospital leaders oppose repeal

In twenty twenty-four, Tennessee's hospital association opposed repeal efforts. Martin Chaney, CEO of Maury Regional Health, warned that ending the law would create rural healthcare deserts by allowing hospitals to cherry-pick profitable areas.

“The premise that eliminating CON regulations will expand health care opportunities by increasing competition is not true for ALL Tennesseans.”

HCA builds despite opposition

A month after the hospital association's letter, TriStar Health, owned by HCA Healthcare, applied for certificate of need to build a hospital twenty minutes north of Maury Regional Medical Center and received approval.

Smaller systems fear consolidation

Judy Herbert, a Williamson County commissioner and board member at Williamson Health, said ending certificate of need laws will prompt hospital closures as big systems dominate rural markets and smaller hospitals lose revenue.

Williamson Health sells to Ascension

In late July, Williamson Health's board voted to sell its network of clinics, diagnostic centers, and more than three hundred thirty-bed hospital in a nine hundred million dollar deal with Ascension St. Thomas.