Tennessee Bill Could Reduce State Oversight of Ballad Health

Amendment would eliminate Tennessee Department of Health's role in ensuring Ballad Health provides better quality, access, and pricing than a competitive market.

Published on Mar. 9, 2026

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An amendment to a Tennessee bill related to health care facilities could reduce the state's current level of oversight of hospital system Ballad Health, which operates an inpatient hospital monopoly in Northeast Tennessee and Southwest Virginia. The amendment would eliminate the role the Tennessee Department of Health (TDH) plays in ensuring Ballad provides better health care quality, access and price than area residents would get in a competitive market.

Why it matters

Ballad Health was formed through the merger of formerly competing hospital systems, which was approved by Tennessee and Virginia under a 'Certificate of Public Advantage' (COPA) that required ongoing state oversight to ensure the public benefit outweighed the lack of competition. This amendment would significantly reduce that oversight, raising concerns about Ballad's market power and ability to control prices and quality.

The details

The amendment would end most of the COPA under which Ballad operates by June 30, 2028, or sooner if 'inpatient acute care competition is restored' in Ballad's service area. After that, any existing pricing restrictions would remain under the oversight of the state attorney general's office until July 1, 2033. The Tennessee Department of Health would no longer play a role in supervising Ballad's compliance with quality, access and pricing commitments.

  • The amendment would terminate the COPA on June 30, 2028, or sooner if competition is restored.
  • Any pricing restrictions would remain under attorney general oversight until July 1, 2033.

The players

Ballad Health

A hospital system that operates an inpatient hospital monopoly in Northeast Tennessee and Southwest Virginia, formed through the merger of formerly competing systems.

Tennessee Department of Health (TDH)

The state agency currently responsible for overseeing Ballad Health's compliance with quality, access and pricing commitments under the COPA.

Tennessee Attorney General's Office

The state agency that would take over oversight of any remaining pricing restrictions on Ballad Health after the COPA is terminated.

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What they’re saying

“Whether the COPA exists in its current form or something different, the oversight of anti-trust in Tennessee lies with the Attorney General, who acts independently.”

— Ballad Health (Ballad Health statement)

“Whether under the oversight of the COPA at the Department of Health, or under the authority of the Attorney General, who has the authority to take action if there is anti-competitive behavior of any kind, Ballad Health will continue to comply with state and federal anti-trust law, and would expect swift and serious action by the Attorney General if it were to violate such law.”

— Ballad Health (Ballad Health statement)

What’s next

The amendment has not been officially attached to a bill yet, but if it is passed, it would eliminate the Tennessee Department of Health's oversight role over Ballad Health starting in June 2028.

The takeaway

This amendment raises concerns about Ballad Health's market power and ability to control prices and quality without the same level of state oversight that has been in place since the company was formed through a merger that reduced competition in the region.