District 3 voters — Washington, Unicoi, and Carter counties — go to the polls August 6 to choose between incumbent State Sen. Rusty Crowe and Johnson City businessman Dan Pohlgeers in the Republican primary. This article does not tell anyone how to vote. It does something simpler: it lays out the documented record of the relationship between the senator and the largest corporation in his district, with a source for every fact. Read it. Check it.
Most voters in Northeast Tennessee know Rusty Crowe’s name. He has represented District 3 in the State Senate since 1990 — thirty-six years. He chairs the Senate Health Committee, making him one of the most powerful health care lawmakers in Tennessee.
Fewer voters know this: the chairman of the Senate Health Committee is a paid contractor of Ballad Health — the hospital monopoly his own legislation helped create.
That is not a rumor, and it is not this newspaper’s characterization. It comes from Crowe himself, from state disclosure records, and from national health care journalists who documented it. Here is the record.
He helped create the monopoly
In 2015, Tennessee passed the legislation that made Ballad Health possible — a law allowing two competing hospital systems, Mountain States Health Alliance and Wellmont Health System, to merge under a state-issued shield called a Certificate of Public Advantage, or COPA. The COPA’s function is blunt: it protects the merged company from federal antitrust law. Without it, the merger that created Ballad could not have survived.
KFF Health News, one of the nation’s leading nonprofit health newsrooms, reported it plainly: “Tennessee began to pave the way for Ballad in 2015 when state Sen. Rusty Crowe (R-Johnson City) co-sponsored a bill allowing for the merger, which was later mirrored in Virginia.”
The result, formed in 2018, is Ballad Health: the sole hospital system across a 29-county region of Northeast Tennessee and Southwest Virginia serving roughly 1.1 million people — what KFF and others have described as the largest state-sanctioned hospital monopoly in the United States. If you live in District 3, there is no other hospital system. Every emergency room is Ballad’s.
He was being paid while he did it
Here is the fact that turns a policy story into an accountability story, reported by KFF Health News and confirmed by the senator himself:
“Crowe was also working as a contractor for Mountain States Health Alliance when the bill was introduced, and since the merger he has been similarly contracted with Ballad, the lawmaker said.”
Read the timeline in that sentence. Crowe was under contract with Mountain States — one of the two merging systems — at the moment he co-sponsored the bill that allowed the merger. After the merger created Ballad, the contract continued with Ballad. The money never stopped; only the name on it changed.
How much money? The public is not allowed to know. Again, KFF Health News: “Tennessee financial disclosure records confirm Crowe was paid by both hospital systems but don’t say how much or for what.” Tennessee’s disclosure law requires legislators to name their sources of income — not the amounts. So the public record establishes that Ballad pays the chairman of the Senate Health Committee, and stops there.
Crowe has said the work involves helping develop wound care and hyperbaric medicine services; the Tennessee Lookout reported in 2024 that he “contracts with the hospital system to run bariatric treatment services.” He has stated that he “complied with all the Senate ethics code requirements regarding any potential conflict of interest.” No one has charged him with violating any rule. That is not the question this article raises. The question is what the rules allow — and what voters think of it.
When Ballad wanted records hidden, he filed the bill
In February 2018 — the same year Ballad was formed — the Johnson City Press reported: “Crowe files bill shielding certain Ballad Health information from public record.”
Ballad had asked lawmakers to keep certain records it deemed “competitive” confidential — exempt from Tennessee’s Public Records Act, the law that lets citizens see what entities operating under state authority are doing. The bill to deliver that confidentiality was filed by the senator Ballad was paying.
Consider what the COPA arrangement is supposed to be. Ballad is not an ordinary private company; it operates as a monopoly only because the State of Tennessee actively supervises it in the public’s name. Public oversight is the entire trade. A bill shielding the monopoly’s records from the public cuts at the very mechanism that is supposed to make the monopoly tolerable — and it was sponsored by a lawmaker under contract with the company.
When the monopoly was challenged, it ran through his committee
Because Crowe chairs the Senate Health Committee, legislation about Ballad’s monopoly passes through the gavel of a Ballad contractor.
In 2024, when a bill was brought to prevent medical monopolies like Ballad’s from continuing, critics said outright that Crowe “had a conflict of interest as chairman of the Senate Health Committee.” The bill died. Crowe said he had planned to declare a conflict of interest before the committee discussed it, and defended the merger itself: “Our community as a whole asked us to please put these two (hospital systems) together.”
This year the stakes rose again. In 2026, the Tennessee House passed legislation to dissolve the Ballad COPA entirely, sending the fight to the Senate — where the Health Committee chairman is a Ballad contractor. In April 2026, Federal Trade Commission staff weighed in on the COPA’s future as Tennessee weighs whether the arrangement should survive. Whatever happens next session, the monopoly’s fate will once again run through the committee Rusty Crowe chairs.
The choice in front of District 3
Dan Pohlgeers, a Johnson City businessman, is challenging Crowe in the August 6 Republican primary. This article makes no endorsement. It asks the only question journalism is for:
Do the voters of Washington, Unicoi, and Carter counties believe the chairman of the Senate Health Committee should be a paid contractor of the health care monopoly he helped create, whose payments the public cannot see, and whose records he moved to shield?
That is not a question for a courtroom or an ethics panel. The rules, as written, permit all of it. It is a question only a ballot can answer.
The record: what Rusty Crowe has done for Ballad Health
Every item below is drawn from the named source. Check them.
- 2015 — Co-sponsored the law that made the monopoly possible. “Tennessee began to pave the way for Ballad in 2015 when state Sen. Rusty Crowe (R-Johnson City) co-sponsored a bill allowing for the merger.” (KFF Health News)
- 2015 — He was on the hospital system’s payroll when he did it. “Crowe was also working as a contractor for Mountain States Health Alliance when the bill was introduced…” (KFF Health News, reporting Crowe’s own statement)
- 2018 — Filed the bill to shield Ballad’s records from the public. “Crowe files bill shielding certain Ballad Health information from public record.” (Johnson City Press, February 2018)
- 2018 to present — Has remained a paid Ballad contractor since the merger. “…since the merger he has been similarly contracted with Ballad, the lawmaker said.” (KFF Health News)
- Ongoing — The amounts Ballad pays him are hidden from the public. “Tennessee financial disclosure records confirm Crowe was paid by both hospital systems but don’t say how much or for what.” (KFF Health News)
- Ongoing — He chairs the committee that controls Ballad’s fate. Crowe is chairman of the Senate Health Committee, through which COPA legislation passes. (Tennessee Lookout; Tennessee General Assembly)
- 2024 — The bill to prevent medical monopolies died while critics called out his conflict. Critics said he “had a conflict of interest as chairman of the Senate Health Committee”; the legislation failed. (Tennessee Lookout, March 2024)
- 2026 — As the House votes to dissolve the COPA, the fight moves to his committee’s turf. The Tennessee House passed legislation to dissolve the Ballad COPA; the monopoly’s future now involves the Senate, where Crowe chairs the Health Committee. (WCYB; FTC staff comment, April 2026)
One senator. One monopoly. Eleven years of documented service to it — while serving as the district’s voice in Nashville and drawing pay from the company the whole time.
August 6. Read it. Check it. Then decide.
Sources: KFF Health News, “These Appalachia Hospitals Made Big Promises to Gain a Monopoly. They’re Failing to Deliver.”; Tennessee Lookout, “Bill averting medical monopolies dies in House subcommittee” (March 27, 2024); Johnson City Press, “Crowe files bill shielding certain Ballad Health information from public record” (February 8, 2018); WJHL, “JC businessman Dan Pohlgeers to challenge Rusty Crowe in GOP primary”; WCYB, “Tennessee House passes legislation to dissolve Ballad COPA”; Federal Trade Commission staff comment on the Ballad Health COPA (April 2026); Tennessee General Assembly member records.
