2025 Health Year in Review: COPA, financial troubles and Medicaid

Health care is one of the most defining topics in the U.S. right now. While many agree that the system needs fixing, rifts on how to get it done mark both federal and local policy. The year in health was defined in rising costs nationwide and debates over rural care. That squeeze contributed to some of the most defining moments we felt at home. Here's a brief recap on 2025. First COPA hearing in two years In the first public hearing on Ballad Health's Certificate of Public Advantage since 2023, reviews were pretty evenly split. More than 20 people spoke at the November event hosted by the Tennessee Department of Health. Concerns echoed those from 2023; about half of the speakers cited issues with quality of care, accountability and facility closures and consolidation. Others spoke to the excellent care they said they received through Ballad, with an emphasis on cancer and substance use treatment. The event had lots of eyes on it — while dozens attended in person, Six Rivers Media's livestream garnered more than 9,500 views. Health Commissioner John Dunn said the health department will review all comments from the hearing, including those submitted online. The department will likely publicly publish them later this year, like it did after the last hearing. Optum takes over HMG, SOFHA struggles Optum, a subsidiary under UnitedHealth Group, took over Holston Medical Group in Kingsport in August. It's one of the latest medical groups to join a long list of UnitedHealth acquisitions. The corporation has been a major driver of mergers and acquisitions over the past decade. Optum itself employed or was affiliated with about 10% of all practicing physicians in late 2023. It's uncertain how the transition will play out over the long run. At the time, HMG did not respond to multiple requests for comment. An Optum spokesperson confirmed the move but did not provide further details. While a health care leviathan took on HMG, the State of Franklin Healthcare Associates faced its own struggles. On Sept. 17, the Johnson City-based group sued Summit Medical Group in Knoxville for "orchestrat[ing] a scheme" to turn SOFHA's employees against them. Amid it all, patients said they were left in the dark with little to no communication from SOFHA. The group kept some of its physicians, but the lawsuit is ongoing. Most recently, Ballad Health pledged financial support to the group to help it resolve debt. Both groups said SOFHA decisions will remain independent. Unicoi County Hospital rebuild unclear September marked the year anniversary of Hurricane Helene, which wiped out the Unicoi County Hospital in Erwin. While Ballad Health officials remain committed to a rebuild, Medicaid cuts included in the 'One Big Beautiful Bill' have raised cost issues. The rebuild will cost around $50 million, as estimated by Ballad Chief Operating Officer Eric Deaton and Chief Executive Officer and Chairman Alan Levine. Deaton said in September that upcoming Medicaid cuts under the law would impact the hospital's ability to operate with a positive margin. The health system also announced in September that it has an option on another property in the community. In the same month, Deaton said canceling the rebuild is "a real possibility." The health system could look at care options outside of a hospital, he added. Federal changes to Medicaid, ACA premiums Federal changes to Medicaid and the Affordable Care Act have rocked the nation. In Tennessee, KFF estimates that new policies will increase the uninsured population by about 68,000 people. The nonprofit predicts that 24,000 of these people will lose insurance because of cuts to Medicaid under the One Big Beautiful Bill. About 40,000 residents will lose insurance because of changes to Obamacare. Most notable is the expiration of insurance subsidies passed during the Obama administration and expanded during the COVID-19 pandemic. They expired at the end of 2025, leaving many in the area with an expected doubling of their premiums. The Rural Health Transformation Program To address concern about the Big Beautiful Bill's impact on rural hospitals, federal legislators created a fund that will give states $50 billion over five years to improve rural health care. In its application to the fund, Tennessee outlined a variety of multi-year programs that would total $928.5 million. Its bid also revealed a state investment of $125 million for rural health. The federal government gave the state $206.8 million for fiscal year 2026. State health department officials have not yet responded to questions about how those funds will be allocated. Experts say it's not enough. KFF estimates that federal Medicaid spending in rural areas will decrease by $137 billion over 10 years, including an estimated $1.76 billion reduction in rural Tennessee. The federal fund makes up only about a third of that loss.