Three key political decisions made in Tennessee higher education that have brought about major changes in structure and have implications for the future are discussed. The decisions are: creation of the Tennessee Higher Education Commission (THEC) in 1967, the creation of the State Board of Regents (SBR) in 1972, and the establishment of the second publicly-supported medical school in 1974. In examining the decisions, it is important to consider where the political power structure existed prior to the decisions and the source of that power. The THEC is a coordinating board consisting of nine lay board members appointed by the Governor and representing each congressional district. They coordinate the state-supported universities, community colleges, and technical institutes. The SBR is a lay board consisting of 11 public members appointed by the Governor and four ex-officio members and is responsible for the operation of 6 universities and 10 community colleges. The second medical school is part of East Tennessee State University in Johnson City, Tennessee, and its primary emphasis is on training family practice physicians to practice in underserved areas of the state. The history of these three developments is detailed in the report's three chapters. Policy statements and the text of state legislation concerning these decisions are appended. (SW)