Stories to Watch in 2026: Health Insurance Woes

For those who don't have access to workplace medical insurance, there are two options for coverage: Medicaid and the Affordable Care Act — unless a person ultimately isn't able to obtain either. This year, both ACA and Medicaid are seeing changes that will leave more Tennesseans in the coverage gap.

ACA (commonly known as Obamacare) saw enhanced premium tax credits expire at the end of 2025. This fact already caused premiums for 2026 to increase by an average of 26 percent nationally. In some cases, premiums doubled or tripled — including in Nashville. That's because only the people who need it most will apply for coverage, and some will forgo applying altogether, leaving those who do enroll with a larger portion to pay. The open enrollment period lasts from Nov. 1 to Jan. 15 each year.

While all of the ACA plans are subsidized based on the user's income, enhanced premium tax credits were introduced in 2021, in the thick of the pandemic, to make insurance more affordable for a larger group of people than otherwise. Before the enhanced tax credits, ACA was limited to people who made 100 to 400 percent of the federal poverty level, creating an "income cliff." Enhanced subsidies removed the income cap.

The debate over the enhanced tax credits is one of the issues that kept the government shutdown at a stalemate in the fall. And despite efforts from some moderate Republicans in the U.S. House to extend the credits for at least a year, before Christmas the House passed a bill that did not extend the credits. The U.S. Senate is set to deliberate on the matter this month.

The U.S. Congress Joint Economic Committee estimates that as many as 225,802 people will lose ACA coverage in Tennessee due to the expiration of enhanced tax credits. In addition, the committee predicts 69,765 will lose Medicaid coverage in Tennessee by 2034 due to cuts to Medicaid under the Trump-backed "One Big Beautiful Bill."

People often turn to ACA coverage if they don't qualify for Medicaid for one reason or another. Tennessee has a 9.3 percent uninsured rate, putting us among the 10 least-covered states in the country. At the state level, legislators have continually shot down federal funding to expand Medicaid coverage to people who do not get insurance through their jobs. Tennessee is one of just 10 states that has not expanded Medicaid coverage, meaning adults without children and those younger than 65 are not covered under the program.

The coming change will also impact rural hospitals, which get the majority of their funding from Medicaid. (Because of this, the federal government added a $50 billion stabilization fund for rural hospitals over five years.)