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Note from The Tennessee Conservative: Editorial statements in this column are the sole opinion of the author; they do not necessarily reflect the opinions of the staff of this publication.
Submitted by Danielle Goodrich (Chair of the Washington County Republican Party) –
Let’s talk about healthcare—because what’s being passed right now will directly impact every family in Northeast Tennessee.
There is a plan to dissolve the Certificate of Public Advantage (COPA) by 2028 with legislation passing Senate Health. At first glance, that may sound like long-overdue reform. But buried in the details is a serious problem that has not been clearly explained to the public.
Under the current proposal, COPA would be eliminated on June 30, 2028, while the Certificate of Need (CON) law for hospitals would not be fully repealed until June 30, 2030.
That creates a two-year gap.
For those two years, our local healthcare monopoly would operate with less oversight and zero competition.
Less oversight. No competition.
That is not reform. That is a dangerous expansion of monopoly power.
To understand why, you need to understand the difference between COPA and CON.
COPA is the agreement Ballad Health made with the State of Tennessee when the system was created. It was designed to protect the public by requiring certain standards—quality of care, access to services, staffing levels, keeping facilities open, and some level of cost oversight. In short, COPA is the only mechanism currently in place to hold Ballad accountable.
Has it worked perfectly? No. Particularly after COVID, many of those standards were weakened or poorly enforced.
Do we eventually hope to do away with COPA? Yes. Because the true goal is not to have a healthcare monopoly, but have healthcare competition.
Article 1, Section 22 of the Tennessee Constitution states that monopolies are contrary to the genius of a free state, and shall not be allowed. This phrase suggests that monopolies are fundamentally incompatible with the principles of liberty and equal opportunity in a free society.
CON, is what prevents competition.
It is the law that makes it extremely difficult—often impossible—for new hospitals, clinics, or independent providers to enter the market. Without repealing CON, there is no meaningful way for competitors to challenge Ballad Health.
That lack of competition is already being felt. Independent providers are being squeezed out, patients have fewer choices, and both costs and quality inevitably suffer when a single system dominates an entire region.
Our County GOP passed a resolution for immediate repeal of CON. I am happy to see movement on this issue, however repeal needs to be in the correct order.
This brings us to the core issue.
If COPA is eliminated while CON remains in place, it does not dismantle the monopoly—it strengthens it. This would remove roughly two-thirds of the existing oversight—cost, quality, and access monitoring—while still blocking any new competition from entering the market.
That is the worst of both worlds.
A practical, common-sense approach is straightforward.
Competition should come first. Oversight should remain in place until real alternatives exist. Only after a truly competitive market develops should oversight be reduced.
In practical terms, that means:
• Repeal or significantly reform CON to allow competition into Northeast Tennessee
• Keep and enforce COPA in the meantime to maintain accountability
• Consider phasing out COPA only after meaningful competition exists
Encouragingly, there is an effort underway to correct this imbalance.
An amendment has been proposed by Representative Timothy Hill that would align the phase-out of both COPA and CON in Northeast Tennessee to the same date—June 30, 2028—effectively eliminating the two-year gap. The approach is simple: if COPA is repealed in a region, that region should also be free from CON barriers at the same time.
This sequencing matters. Without it, the result is predictable: a stronger monopoly with fewer checks and no alternatives.
The goal should be clear—real choice, real accountability, and real competition. Anything less risks making an already difficult situation worse.
Those who care about access to quality healthcare in Northeast Tennessee should make their voices heard in support of aligning these reforms and ensuring that competition and accountability move forward together—not years apart.
