NASHVILLE, Tenn. — Health care costs have become one of the sharper issues in the race for Tennessee governor, after more than 71,000 Tennesseans gave up marketplace health insurance they could no longer afford once enhanced federal premium subsidies ran out.
Those pandemic-era tax credits expired on Dec. 31, 2025. They had fueled a surge in sign-ups: nearly 643,000 Tennesseans bought Affordable Care Act marketplace plans in 2025, more than twice as many as in 2020, before Congress boosted the subsidies.
The biggest growth came among lower-income households. Enrollment among people earning between 100 and 150 percent of the poverty level climbed from about 49,000 to more than 372,000 over those five years. Marketplace plans reached every one of the state’s 95 counties, covering anywhere from 5.2 percent of residents in Trousdale County to 12.3 percent in Davidson.
With the extra help gone, insurers planned for higher 2026 premiums, anticipating that healthier and lower-income customers would be the first to drop out. More than 9 percent of Tennesseans now have no insurance at all, either because they fall outside TennCare eligibility or because private plans cost too much.
Unpaid bills weigh on households too. About a fifth of Tennesseans owe medical debts that have landed with collectors or show up in their credit files, which ranks the state among the highest in the nation.
Rising uninsured numbers ripple through the health system. People without coverage often put off care, which can worsen their health, and they lean more on emergency rooms, adding uncompensated care costs for hospitals and providers.
The four candidates polling above 1 percent, Republican nominee Marsha Blackburn, Democratic nominee Jerri Green and independents David Hatley and Lauren Pinkston, have laid out different approaches, from expanding Medicaid to opening up the insurance market, training more health workers and wiping out medical debt. Election Day is Nov. 3.
Filed under: Nashville TN Health News
