Fentanyl & Heroin — As the opioid epidemic evolves, overdose deaths from fentanyl and heroin are surging while deaths from prescription pain relievers fall. Recession Readiness — History suggests Tennessee’s 50th governor will face a recession while in office. Meanwhile, the state budget has about 40% less cushion today than in 2007, before the last big recession. Workforce Health — Even without a recession, Tennesseans’ below-average health prevents our economy from reaching its full potential. Online Sales Tax — With online shopping on the rise, Tennessee collects sales tax on a smaller share of consumer spending than in the past. A 2018 U.S. Supreme Court ruling lets states change their tax laws to include more online sales. Access to Health Care — Tennessee faces many health care access challenges, including a 9.5% uninsured rate, hospital closures, rural provider shortages, addiction treatment capacity, insurance costs, decisions about TennCare, and potential federal policy changes.