Search the term "certificate of need" on the Tennessee General Assembly website, and 15 various House and Senate bills pop up.
Although still in their infancy, these bills are a clue that legislators will try to alter health care regulation in the state, whether its minor tweaks or sweeping changes similar to Georgia's House Bill 198.
State Sen. Mike Bell, R-Riceville, said the average person has "no clue" about the certificate of need process.
"But I can tell you that my constituents became very aware of it this last summer," said Bell, whose district includes portions of Bradley, McMinn, Meigs, Monroe and Polk counties.
Bell referenced June 27, 2018 — the day state regulators denied certificate-of-need applications from Chattanooga-based Erlanger Health System and Tennova Healthcare in Cleveland, Tennessee. Approval would have granted the hospitals permission to build free-standing emergency departments in Bradley County.
Dozens of outraged constituents contacted him after that event, Bell said.
"One-hundred percent of those who contacted me who were not associated with the hospital, wanted the two hospitals to be able to build the clinics without government interference," he said.
Along with freshman state Rep. Mark Hall, R-Cleveland, Bell is co-sponsoring a bill that would remove the requirement that hospitals obtain a certificate of need to build satellite emergency departments or offer cardiac catheterization services.
"I think the certificates of need are no more than state governments overstepping boundaries and creating monopolies," Hall said. "Cleveland and Bradley County have experienced so much growth. We need more availability and we need our medical facilities to grow with it.
"I'm certainly not choosing one hospital over the other one, but what I am encouraging is a free market and competition," Hall said.
State Sen. Todd Gardenhire, R-Chattanooga, used to serve on the state board that reviewed certificate-of-need requests.
"I saw first hand how expensive it was and how other people fought it just to protect their turf and basic monopoly," Gardenhire said. "I really came to the conclusion that's one of the reasons why our health care costs are so high."
Gardenhire, who's watched Tennesseans debate related policy for decades, said the last change to the law happened several years ago.
"Of course, those entities that wanted to keep everything like it was were full of gloom and doom they predicted that it would be catastrophic," he said. "Sure enough, the world didn't stop."
To compromise with those who favor the health care regulation, legislators agreed to leave certificate-of-need laws alone for a while. But that moratorium is over now.
Gardenhire, who's crafting his own bill, said he favors small changes that open competition in the cities while protecting rural providers.
"No one wants to cripple the system — we want to improve the system," he said. "That's why we're taking this steps at a time."
Contact staff writer Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.