Tennessee families could see health insurance costs double if Congress fails to act

NASHVILLE, Tenn. (WKRN) — Tennessee families who buy health insurance through the Affordable Care Act could see their premiums soar next year if Congress allows enhanced subsidies to expire.

Some households could end up paying twice as much.

A new analysis from KFF shows insurers are proposing an average 18% increase nationwide in 2026. In Tennessee, premiums could rise by as much as 26%.

For more than 600,000 Tennesseans currently enrolled in Affordable Care Act coverage, the financial strain could be severe.

KFF's analysis found that premiums in Tennessee, which are now buffered by subsidies, would jump significantly if those supports end. A family paying around $74 a month today could see that bill climb to more than $160.

"States like Tennessee, South Carolina, Georgia, Texas, Florida have seen their marketplace populations explode over the last four or five years because of these enhanced premium tax credits," KFF policy analyst Matt McGough said. "It made coverage affordable for many middle Americans who otherwise would have gone uninsured."

The state's reliance on subsidies has grown rapidly.

In 2020, about 246,000 Tennesseans bought insurance through the federal marketplace. By this year, enrollment swelled to 640,000, with nearly all of them depending on the expanded credits to keep premiums low.

Family & Children's Service President and CEO Michael McSurdy said this loss would devastate working families already on tight budgets.

"If the subsidies expire, it's going to be the poorest people who are most impacted because they are going to have the least latitude in making those decisions," he said.

The future of subsidies is caught in a broader budget fight in Washington, D.C. Democrats want to extend the program, arguing it has helped stabilize health care access across the country. Republicans said the program is too costly.

"In some congressional districts that are led by Republicans in the House of Representatives, upwards of 30% of their constituency is now receiving coverage through the marketplace," McGough said. "They will definitely face sticker shock when they go to shop for their plans."

Experts estimated that as many as 400,000 Tennesseans could lose coverage, and they said the impact would be felt most acutely in rural communities.

"If people don't have insurance, rural hospitals and rural clinics lose revenue," McSurdy said. "The impact on those people is going to be lack of health care, period."

Unless lawmakers reach a deal, the changes take effect Jan. 1, 2026.