Madison County’s Ongoing Battle for Healthcare Access
In the mountainous region of western North Carolina lies Madison County, a place where healthcare access remains a pressing issue. With a population of about 22,000, the county has no hospital and relies on just three ambulances for emergency medical transportation.
The ambulances often transport patients to Mission Hospital in Asheville, the area’s largest medical facility. According to Mark Snelson, director of Madison Medics EMS, these trips can exceed two hours. “When we get busy and all three of them are gone, we have no ambulances in our county,” he explained.
County residents, along with officials from the North Carolina Department of Health and Human Services, have identified the need for more acute care hospital beds. The state initially identified a need for 67 additional beds in 2022, which increased to 93 in 2024, and then to 222 by October 15.
Despite the clear need, only a 25-acre field marked “FUTURE HOME OF AdventHealth Weaverville” exists as evidence of progress. The plan for a new hospital, proposed by Florida-based AdventHealth, has faced legal challenges from Mission Hospital’s owner for three years. The hospital was initially expected to open this year, potentially bucking the national trend of rural hospital closures.
The Certificate of Need Dilemma
North Carolina’s certificate of need (CON) law, intended to regulate healthcare expansion by demonstrating necessity, has paradoxically delayed the Weaverville hospital project. These laws are designed to prevent excessive healthcare facilities but have led to legal entanglements, as seen in other states like Oregon, Connecticut, and South Carolina.
Initially mandated by the federal government until 1987, CON laws are still in place in 35 states, with 12 having repealed them. Critics, including former President Donald Trump’s Federal Trade Commission and Department of Justice, argue these laws hinder healthcare access and increase costs. Some states, like Montana and South Carolina, have weakened or repealed these regulations.
Opposition to North Carolina’s CON law has been evident in the state’s legislature and Superior Court. A bill to repeal the law has been stalled since April, while some healthcare industry groups and economists defend the laws for controlling unnecessary expansions and inflation.
Contested Healthcare Territory
Mission Health, North Carolina’s largest healthcare network now owned by HCA Healthcare, argues it is best suited to meet the area’s needs. Mission Health spokesperson Nancy Lindell stated, “Instead of adding more beds at facilities that are unable to provide the complex medical and surgical care needed, the region would be better served by expanding bed capacity at Mission Hospital.”
Meanwhile, an eye surgeon’s lawsuit against the state’s health agency highlights the law’s restrictive nature. The surgeon, Jay Singleton, claims the CON law impedes his ability to perform surgeries at his own center.
In November, various entities, including Republican state Treasurer Brad Briner and the State Employees Association of North Carolina, filed briefs supporting the lawsuit. Thomas Stratmann, a George Mason University professor, criticized the law as a “permission slip to compete,” likening it to a fast-food chain needing state approval to open next to a competitor.
The Federal Trade Commission and Department of Justice have long opposed these laws, citing their restrictive impact on competition and innovation.
The Human Impact
Madison County Health Department Director Tammy Cody emphasized the real-world implications of delayed healthcare access: “This isn’t theoretical — it’s personal,” she stated. AdventHealth spokesperson Victoria Dunkle shared that despite the legal delays, the organization remains committed to proceeding with the Weaverville hospital to enhance healthcare access.
Mark Snelson, echoing a sentiment shared by many locals, questioned, “Why is it a bad thing for another hospital to come in here to take some of the stress off of Mission?” As he puts it, the new facility would quickly be utilized to capacity.
