Federal Trade Commission Chairman Andrew N. Ferguson warned Tennessee Rep. David Hawk that the interaction between two sets of state bills could produce what the agency called the "worst possible outcome" for hospital-market competition in East Tennessee. The FTC letter targets a timing mismatch between legislation governing Ballad Health's certificate of public advantage and a separate effort to repeal the state's certificate-of-need regime.
The problem is arithmetic. Under HB 2278 / SB 2414, Ballad's COPA would expire June 30, 2028, removing the state oversight framework that currently imposes conditions on the merged system. Under HB 819 / SB 1369, Tennessee's CON regime would not be repealed until July 1, 2030. That leaves a two-year gap in which Ballad would operate free of COPA oversight while CON laws still block potential competitors from entering the market.
The FTC framed that window as the worst of both worlds: a dominant hospital system unbound by the regulatory conditions that justified its creation, while the entry barriers that insulate it from competition remain fully intact.
Ferguson's letter ties the warning directly to the 2018 merger that created Ballad Health. The agency opposed that combination of regional hospital systems in Tennessee and Virginia on antitrust grounds. Tennessee permitted the deal anyway through its COPA framework, which was designed to substitute state oversight for the market competition the merger eliminated.
The FTC's intervention is a policy warning, not a legal action. The agency has no authority to block Tennessee legislation. But the letter puts lawmakers on notice that the federal antitrust enforcer views the current bill pairing as structurally deficient, and it creates a paper trail tying any resulting competitive harm back to the legislative choice.
The two legislative tracks address different problems. The COPA bills govern the oversight regime specific to Ballad. The CON repeal bills address the broader regulatory barrier that requires state approval before new healthcare facilities can be built. The FTC's point is that those two tracks need to be synchronized, or the transition period will entrench the market power the COPA was supposed to police.