Opinion: Finish Repealing Tennessee’s CON Laws
With $206 million in federal funding on the line, the General Assembly has every reason to finish what it started.
The Tennessee General Assembly has convened for its 2026 session, and lawmakers once again face critical decisions impacting healthcare, the state’s economic future and the well-being of its communities. Few issues sit more squarely at the intersection of those priorities than healthcare access. Specifically, repealing Tennessee’s burdensome Certificate of Need (CON) laws.
The progress made in recent years on reforming the state’s CON laws is promising, but unfinished. Accordingly, this session presents an opportunity to complete the job.
In fact, Tennessee Governor Bill Lee emphasized this in his final State of the State address on February 2nd. While emphasizing the need for increased healthcare access across the Volunteer State, Governor Lee cited repealing harmful CON laws as a key objective for the General Assembly in 2026, noting that doing so “will mean more providers in rural counties, shorter wait times, and care closer to home.”
That’s because CON laws reduce access to affordable, high-quality care, limit patient choice, and grant government control over decisions that should rest with patients and providers. While lawmakers in the last session generated important momentum on the issue, Tennessee’s remaining CON requirements continue to block investment, stifle competition and slow the expansion of healthcare services across our state.
At their core, CON laws require healthcare providers to ask government permission before building new facilities or expanding services. That process places enormous power in the hands of unelected bureaucrats and gives incumbent providers the ability to object to new competitors. Predictably, those incumbents often fight to preserve their market position, even when communities clearly need more healthcare options.
That approach makes little sense in a state growing as quickly as Tennessee.
Since 2022, Tennessee has ranked among the top states nationally for population growth, and projections show the state approaching eight million residents by 2040. Even without that projected growth, patients in many communities already experience long wait times and reduced access to care. In Murfreesboro, for example, efforts to build a new hospital to meet rising demand have remained stuck in the CON process for years, despite its clear need.
The costs of those delays are not hypothetical. According to the Beacon Center of Tennessee, CON laws denied more than $700 million in proposed healthcare investment across the state between 2000 and 2022. During that same period, Tennessee missed the opportunity to open as many as 63 additional hospitals, including up to 25 in rural areas—not to mention CON laws blocked projects that would have increased access to care for more than 5.5 million Tennesseans. These numbers represent real patients, real communities and real consequences.
The COVID-19 pandemic only underscored the dangers of this sort of centralized control over healthcare infrastructure. When capacity matters most, artificial restrictions on supply put patients at risk. A system that requires providers to navigate years of red tape and hundreds of thousands of dollars in application costs before serving patients fails the very people it claims to protect.
The case for full repeal, however, extends beyond access and competition. It also aligns directly with national priorities under President Trump’s leadership. The Trump administration has criticized certificate-of-need (CON) laws as among the worst anti-competitive healthcare regulations and repeatedly urged states to repeal them. That position carries renewed importance today, as Tennessee competes for federal support through the Rural Health Transformation Program established by the One Big Beautiful Bill.
The Rural Health Transformation Program offers states a significant opportunity through grant funding to strengthen rural healthcare systems. States that demonstrate a serious commitment to reducing regulatory barriers and encouraging private investment stand in a stronger position to receive larger awards.
In line with that, as part of its grant application, Tennessee made a strong commitment to pass legislation to eliminate CON laws during the current legislative session, making the reform effective in January of 2027.
Following through on that commitment will ensure the state retains all of the more than $206 million grant provided for 2026 under the program. Failure to meet that commitment puts Tennessee at risk of having to return some of that money back to the federal government and could significantly limit the state’s ability to maximize much-needed rural healthcare funds in future years.
Tennesseans understand what is at stake. More than 45,000 residents have contacted their legislators urging full repeal of the state’s CON laws. That grassroots engagement reflects a broad recognition that patient need, not government red tape, should decide when a community deserves a new hospital, clinic or healthcare service.
This legislative session offers a clear choice. Lawmakers can allow outdated regulations to continue limiting access, investment, and innovation, or they can finish the work they started and fully repeal Tennessee’s remaining CON requirements.
Tennessee often takes on policies that promote free markets and fair opportunity. Fully repealing CON laws is consistent with those principles and with the needs of communities across the Volunteer State. As the General Assembly begins its work, finishing CON repeal should stand at the top of the agenda.
Jeffrey Mazzella is a Tennessee resident and President of the Center for Individual Freedom.