Tennessee has had a longstanding law requiring state board approval before opening a health care facility.

The Tennessee Hospital Association has fought against certificate of need reform for years because many hospitals it represents work under a model where they use money-making procedures such as heart and knee surgeries to offset the cost of providing charity care to those they’re required to treat like a patient who comes to an emergency room but can’t afford to pay.

“Certificate of need helps level the playing field by preventing providers who are not subject to the same federal regulations as hospitals – such as the requirement to provide care to everyone, regardless of their ability to pay – from cherry picking only the most profitable patients and services,” the state’s hospital association said...

Those against Hospital's Certificate of Need include, "conservative interest groups like the Beacon Center and Center for Individual Freedom, and HCA Healthcare, the largest for-profit hospital company in the nation."

Starting in July 2028, new acute care hospitals will no longer be required to go before the state’s healthcare facility commission to receive a certificate of need, CON, before opening.
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This year’s effort was boosted by a demand from President Donald Trump’s administration, tying the repeal of the state’s CON law to receiving a portion of Tennessee’s $1 billion rural health transformation grant.

The organizations/businesses that want to open new hospitals will not be doing it in the rural areas that have the most need. They want to take away from the urban areas. This will hurt the hospitals we have that do good work.