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House subcommittee advances bill to lift certificate‑of‑need for hospitals amid rural access debate
Summary
Representative Garrett's bill to remove acute‑care hospitals from Tennessee's certificate‑of‑need (CON) process advanced out of the House Health Subcommittee after divided testimony from hospital leaders, rural providers and legal experts. The panel voted 5‑1 with three present not voting to send the measure to the full Health Committee.
The House Health Subcommittee on Wednesday approved House Bill 819, a measure that would eliminate certificate‑of‑need (CON) requirements for acute‑care hospitals, advancing it to the full House Health Committee despite pointed debate over rural hospital stability.
Proponents, including legal advocates and some hospital executives, argued that removing CON for acute care would reduce barriers to needed hospitals and speed access to services. Killeen Lindgren of the Pacific Legal Foundation, which litigates constitutional and regulatory cases, told the subcommittee that four decades of research show CON laws correlate with fewer hospitals, higher costs and reduced services. "The average patient in a CON state has access to 30% fewer hospitals," Lindgren said, citing peer‑reviewed summaries.
Hospital representatives and rural leaders urged caution. Lacey Blair of the Tennessee Hospital Association and Frida (Bridal) Russell, chief administrative officer of Ascension Saint Thomas Three Rivers and Waverly, warned that abrupt removal of CON protections could destabilize small rural hospitals, which rely on carefully tailored services and affiliations to remain solvent. "No vote on House Bill 819 protects Tennessee hospitals, rural communities, and the patients who rely on them," Russell said.
Charlotte Burns, a retired rural CEO and current HCA TriStar executive with extensive CON and licensing board experience, supported advancing the bill and argued that elimination would not trigger a proliferation of hospitals in rural markets. "Elimination of CON for acute care hospitals will not result in a proliferation of hospitals," Burns said, and called for quicker access to care and reduced costs associated with the CON process.
Representative Garrett, sponsor of the measure, said he planned to keep the bill in full committee for further discussion and work, acknowledging the complexity and the need for more data on payer mix and local impacts. After debate, the clerk recorded 5 ayes, 1 nay and 3 present‑not‑voting; the subcommittee's chair announced, "House Bill 819 moves on to Health Full." Supporters asked for follow‑up work; opponents asked that the phased CON reforms passed in 2024 be allowed to take effect before further changes.
The vote reflected divided views among hospital systems, rural providers and legal advocates over whether CON is a public‑health protection or an outdated barrier to competition and access. The bill now proceeds to the full House Health Committee, where members said they intend to continue examining payer‑mix safeguards and other transitional protections for rural providers.
