2026年10月19日 / 美国东部时间早上5:00 / KFF健康新闻
特朗普政府将联邦医疗资金与各州是否终止或放宽对新建医院建设具有强大约束力但存在争议的法规挂钩，目前已有数个州准备遵从这一要求。
通过五年期《农村医疗转型计划》可分配给各州的500亿美元资金中，有一部分与政策承诺挂钩。政府告知各州，如果各州撤销或放宽“医疗资质认定（CON）”法规，其申请将获得更高评分。这类法规赋予州政府对任何医疗设施扩建或新建的审批权。已有六个州在申请中表示计划重新审视相关法规。
医疗资质认定法规要求医疗服务提供者证明社区对新服务存在需求，初衷是遏制垄断和医疗成本上涨。但该法规的批评者称，其反而推高了医疗价格、阻碍了必要设施的建设，并剥夺了农村患者获取新技术的机会。根据全美州议会联合会的数据，全美已有超过30个州及华盛顿特区实施了某种形式的医疗资质认定法规。
多年来，两党政府都对这类法规进行过审查，多个州的议员一直推动废除该法规。但特朗普政府将政策与资金挂钩的强硬做法，迫使各州迅速重新审视自身的相关法规。
《农村医疗转型计划》是特朗普总统标志性的《一项宏大美丽法案》中新增的内容，旨在推动偏远地区医疗体系现代化。美国医疗保险与医疗补助服务中心在给各州的项目申请通知中，称医疗资质认定法规“给农村医疗机构带来了额外开支和负担”，并解释了医疗资质认定法规较少的州将获得更高评分的原因。
奇普·索莫德维拉 / 盖蒂图片社
“这并非联邦政府首次以资金作为‘胡萝卜’（而非‘大棒’），来鼓励各州配合政府的政策目标，”美国州卫生政策研究院研究员莫琳·亨斯利-奎因在电子邮件中说道。她指出，巴拉克·奥巴马总统政府曾为那些简化儿童参保联邦医保流程的州提供数百万美元的绩效奖金。
亨斯利-奎因表示，这笔资金“诱饵”为各州提供了一次认真审视医疗资质认定等政策是否真正值得保留的机会。
“无论如何，各州都需要仔细权衡支持这项‘自愿性’联邦政策的利弊，”她说，“额外的联邦资金，尤其是在州预算紧张的年份，可能会成为决定性因素。”
奥巴马与特朗普立场一致
自《农村医疗转型计划》去年正式立法以来，田纳西州已采取了最具体的行动。今年4月，该州议员以两党投票方式通过一项法案，将在未来四年内逐步废除其剩余的大部分医疗资质认定法规。阿拉斯加、康涅狄格、特拉华、爱荷华和密西西比州也表示，将考虑终止或放宽本州的相关法规。
“如果有一个议题能让奥巴马总统和特朗普总统达成共识，这说明这个想法可能具备一定合理性，”南卡罗来纳州共和党参议员韦斯·克莱默在2021年支持废除本州医疗资质认定法规时表示。该州议会于2023年投票决定废除大部分相关法规，并将于明年1月停止对新建医院或扩建项目要求医疗资质认定申请，仅将该要求保留在养老院领域。
部分医疗资质认定法规甚至要求对更换一件昂贵新设备这类微小改动进行审批。在北卡罗来纳州，一家医院虽获得医疗资质认定以建设急需的新设施，但陷入了长达三年的诉讼纠纷，直到2026年才破土动工。
安德鲁·琼斯 / KFF健康新闻
随着越来越多的州考虑废除医疗资质认定法规，亨斯利-奎因警告称可能会产生意想不到的后果：各州用于追踪医院所有权的记录将减少。
亨斯利-奎因表示，已有多个州在废除医疗资质认定法规数年后，沮丧的州官员前来咨询，称即便有许可流程，他们也无法了解本州医疗系统或医疗机构的财务状况以及管理情况。医疗资质认定法规要求寻求在本州拓展业务的公司提交大量申请文件。一旦该法规被废除，几乎没有其他规定能强制要求透明度。例如，当医疗系统与私募股权公司合作提供医院服务时，州政府将无从知晓。
“没有医疗资质认定法规，没有所有权报告，也没有相关实体以这种方式监督交易或医疗机构，你们将无从知晓相关情况，”亨斯利-奎因说道。
田纳西州的医疗资质认定法规
田纳西州议员多年来一直推动修改本州的医疗资质认定法规，但直到面临失去联邦资金的风险时，才通过了全面的相关立法。与所有州一样，田纳西州将获得《农村医疗转型计划》一半拨款的等额份额，而剩余的250亿美元资金则与包括政策承诺在内的其他因素挂钩。
2024年，田纳西州医院协会在一封由12名医院和医疗系统负责人联名的信件中反对废除该法规，其中许多负责人来自农村地区，但这项更为有限的立法仍获得通过。
“废除该法规将推高成本、削减现有医院员工，损害弱势患者的利益，”纳什维尔以南田纳西州中部农村地区医疗系统莫里地区医疗中心首席执行官马丁·查尼说道。查尼在信中写道，废除该法规将导致农村医疗荒漠的出现，因为医院会选择在 already 最盈利、居民拥有多种健康保险的地区进行扩张。
“废除医疗资质认定法规将通过增加竞争扩大医疗服务机会的前提，并非对所有田纳西人都成立，”查尼写道，“相反，这将导致医疗资源的‘挑拣’，加剧农村地区医疗服务可及性的差距。”
一个月后，由美国最大医院公司营利性HCA医疗保健集团所有的TriStar健康系统，申请在莫里地区医疗中心以北仅20分钟车程的区域新建一家医院。尽管莫里地区医疗中心短暂反对，但总部位于纳什维尔的HCA仍获得了审批。
HCA未回应置评请求。
当地领导人对新医院将对该地区医疗服务产生的影响存在分歧。“竞争是好事，”莫里县专员凯文·马克汉姆告诉KFF健康新闻。与其他支持新建医院的人一样，马克汉姆表示，患者在选择就医医院时应该拥有更多选择。
但田纳西州较小医院系统的领导人对此感到担忧。威廉姆森县专员、当地另一医疗系统威廉姆森健康董事会成员朱迪·赫伯特表示，废除医疗资质认定法规将导致医院倒闭。大型医院系统将成为高价医疗服务的默认提供者，并主导农村市场，而此前提供此类服务的小型医院将损失惨重，被迫关门或被收购，赫伯特补充道，这呼应了该法规其他支持者的担忧。
“诸多挑战给医疗机构带来了越来越大的压力，尤其是像威廉姆森健康这样的独立非营利机构，”该医疗系统领导层在2025年7月的一封公开信中说道，信中提及田纳西州围绕医疗资质认定的计划。
2025年7月底，威廉姆森健康董事会投票决定，以9亿美元的价格将其旗下的诊所、诊断中心以及拥有330多张床位的医院出售给Ascension St. Thomas，该公司是美国最大的医疗系统之一。
KFF健康新闻是一家专注于医疗问题深度报道的全国性新闻机构，也是独立健康政策研究、民调与新闻来源KFF的核心运营项目之一。
Trump dangles rural health dollars to push states to change hospital laws
October 19, 2026 / 5:00 AM EDT / KFF Health News
The Trump administration has hinged federal funding for states on whether they end or loosen powerful but controversial laws that regulate the construction of new hospitals — with a handful of states poised to comply.
A chunk of the $50 billion available to states through the five-year Rural Health Transformation Program is partly contingent on policy commitments. The administration told states it would score their applications higher if they walked back their certificate of need, or CON, laws, which give a state approval authority over the expansion or construction of any healthcare facility. Six states indicated plans to revisit their laws in their applications.
Certificate of need laws, which require that a healthcare provider prove a community need for a new service, were intended to curb monopolies and rising costs. But critics of the laws say they’ve instead raised healthcare prices, stalled needed facilities, and barred rural patients from new technology. More than 30 states, plus Washington, D.C., enforce some sort of certificate of need law, according to the National Conference of State Legislatures.
Legislators in several states have been pushing to end the laws, which have faced scrutiny for decades — under Republican and Democratic administrations. But the Trump administration’s aggressive approach to tie the policies to funding has forced states to reckon with their laws quickly.
The Rural Health Transformation Program was added to President Trump’s signature One Big Beautiful Bill Act as an initiative to modernize healthcare in remote areas. The Centers for Medicare & Medicaid Services, in its notice to states applying to the program, called certificate of need laws “an additional expense and burden on rural facilities” and explained how states with fewer certificate of need rules would get higher scores.
President Trump speaks during a “Great, Historic Investment in Rural Health Roundtable” in the East Room of the White House on Jan. 16, 2026, in Washington, D.C. Chip Somodevilla / Getty Images
“It’s not the first time the federal government used funding as a state carrot (versus using a stick) to encourage alignment on an administration’s policy goal,” Maureen Hensley-Quinn, a researcher at the National Academy for State Health Policy, said in an email. She noted that President Barack Obama’s administration included millions of dollars in performance bonuses for states that made it easier for children to enroll in federally funded health insurance.
Hensley-Quinn said the funding “carrot” was an opportunity to take a hard look at whether policies like certificates of need were truly worth it.
“States need to carefully weigh the trade-offs of supporting a ‘voluntary’ federal policy no matter what,” she said, “and additional federal financing, especially in tight state budget years, can tip the scale.”
Obama, Trump on same page
Since the Rural Health Transformation Program became law last year, Tennessee has taken the most concrete action. In a bipartisan vote in April, state lawmakers passed a bill that will unravel most of its remaining certificate of need rules over the next four years. Alaska, Connecticut, Delaware, Iowa, and Mississippi have also said they would consider ending or loosening their laws.
“If there’s an issue where you can have President Obama and President Trump in agreement on something, that tells you the idea probably has some merit,” Wes Climer, a Republican state senator in South Carolina, said in 2021, supporting the repeal of that state’s certificate of need law. The legislature voted in 2023 to end most rules in the law, and in January it will stop requiring certificate of need applications for new hospital construction or expansion, leaving them only for nursing homes.
Some certificate of need laws require approval for changes as minor as a new piece of expensive equipment. In North Carolina, a hospital that won a certificate of need to build a much-needed facility was mired in a court battle for three years before breaking ground in 2026.
The early stages of construction on a hospital underway in Weaverville, North Carolina, in October 2026. The project had been delayed three years, tied up in the state’s certificate of need process. Andrew Jones/KFF Health News
As more states consider removing their certificate of need laws, Hensley-Quinn warns of unintended consequences: Fewer records will exist that help states track hospital ownership.
Hensley-Quinn said frustrated state officials have come to her years after their states repealed certificate of need laws, saying that even with a licensure process, they don’t have insight into the financial state of their health systems or facilities, or how they’re managed. Certificate of need laws force companies seeking a new foothold in the state to submit voluminous applications. Once the laws are gone, few regulations force transparency. That leaves states unaware when a health system contracts with private equity to provide hospital services, for example.
“Without CON, without ownership reporting, and without an entity that monitors transactions or providers in that way, there’s no way for you to know,” Hensley-Quinn said.
Tennessee’s certificate of need law
Tennessee lawmakers had pushed to change the state’s certificate of need law for years but didn’t pass sweeping legislation until it faced losing out on federal funding. Like all states, Tennessee is set to receive an equal share of half of the Rural Health Transformation Program’s grants, while the other $25 billion in funding is contingent on other factors, including states’ policy commitments.
In 2024, the state’s hospital association opposed a repeal effort in a letter penned by 12 hospital and health system leaders, many serving rural areas, though that more limited legislation passed anyway.
A repeal would harm vulnerable patients by driving up costs and thinning existing hospital staff, said Martin Chaney, CEO of Maury Regional Health, a system in rural Middle Tennessee south of Nashville. Ending the law would create rural healthcare deserts, Chaney wrote in the letter, because hospitals would choose to expand in areas that were already the most profitable, where residents had a range of health insurance providers.
“The premise that eliminating CON regulations will expand health care opportunities by increasing competition is not true for ALL Tennesseans,” Chaney wrote. “Instead, it would result in cherry-picking and increasing the gap in access to medical care in rural areas.”
A month later, TriStar Health — owned by the largest hospital company in the U.S., for-profit HCA Healthcare — applied for a certificate of need to build a hospital just 20 minutes north of Maury Regional Medical Center. Nashville-based HCA received approval despite brief opposition from Maury Regional Health, the system led by Chaney.
HCA did not respond to requests for comment.
Local leaders are divided on what the new hospital would do to healthcare in the region. “Competition is good,” Maury County Commissioner Kevin Markham told KFF Health News. Markham, like many in favor of the new hospital, said that patients should have options when it comes to choosing where they get hospital care.
But leaders of smaller hospital systems in Tennessee are worried. Judy Herbert, a Williamson County commissioner and board member at Williamson Health, another health system in the area, said ending certificate of need laws will prompt hospital closures. Big hospital systems will become the default for expensive procedures and dominate rural markets, while smaller hospitals that provided those procedures before will lose so much money, they’ll be forced to shutter or sell, Herbert reasoned, echoing the concerns of other advocates of the laws.
“Many challenges have emerged that place increasing pressure on healthcare organizations, especially independent nonprofits like Williamson Health,” that health system’s leadership said in an open letter in July 2025, citing Tennessee’s intentions around certificates of need.
In late July, Williamson Health’s board voted to sell its network of clinics, diagnostic centers, and a more than 330-bed hospital in a $900 million deal with Ascension St. Thomas, part of one of the largest healthcare systems in the nation.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
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