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Originally published in The Tennessean, July 2025

This year, more than 642,000 Tennesseans bought their own health insurance through the Marketplace. About 95% receive help paying for it through premium tax credits, which lowers their monthly cost of insurance.  

This works a lot like how employers help pay a portion of their workers’ coverage. But people who buy plans on the Marketplace are often self-employed or aren’t offered coverage through their jobs. So, premium tax credits can help instead. 

In 2020, the American Rescue Plan passed by Congress changed the existing law to increase these tax credits. It also allowed more working families to qualify and made sure all qualifying families wouldn’t have to pay more than 8.5% of their income for a plan. 

KFF reported that these enhanced premium tax credits helped drop premiums by about 44% on average.   

Now imagine if these savings went away  

Because that is a real possibility now. Unless new federal legislation is passed, families will lose part or all of their tax credits at the end of the year.  

If they expire, the number of people who qualify could drop quickly. More people in Tennessee would be impacted than in most other states because we’re a lower income state.  

So, many people may need to cancel their coverage because they can no longer afford it without these tax credits. As a result, over 265,000 Tennesseans could lose their premium tax credits – making the impact here especially severe. 

Why it matters to our neighbors 

When people lose health coverage, they don’t stop getting sick or hurt. They stop getting care, often putting their health needs off until they become an emergency – which is also more expensive. 

Depending on the nature of this health emergency, their care needs could also extend beyond a single trip to urgent care or the emergency room. Not to mention people with critical and chronic health needs could also be at risk of losing access to life-sustaining treatment if they can’t afford their health insurance premiums. 

According to Keep Americans Covered, a typical U.S. family of four making $64,000 a year could see their premiums increase by roughly $2,600.

Here in Tennessee, where the average income per year is around $36,000, that cost increase could be even higher. And working families know every dollar counts. 

Most people agree health insurance is a safety net for financial stability. But if the extra tax credits go away, many healthy people may drop their coverage once it becomes too expensive. That leaves fewer people in the system – likely those with more extensive health care needs. 

When that happens, health plans have to pay more in medical bills for each person who stays covered – which raises premiums for everyone. So, even people who can keep their insurance could end up paying more, because fewer people are sharing the cost.    

Why it matters to health care providers 

The removal of those extended tax credits would have a meaningful impact on some of Tennessee’s health care providers, especially those in rural areas. 

These providers are already struggling and could face more challenges from this reduction, too. Last year, we paid out just over $837 million for the medical care our nearly 112,000 Marketplace members needed.  

If these tax credits expire, health care providers could lose much of that revenue because people may delay getting care – or providers may have to consider whether to deliver care without getting paid for it. 

When more people are insured, everyone benefits  

People can get earlier diagnoses and better treatment outcomes, with less strain on emergency rooms. And healthy people are generally more productive which means our workforce can contribute fully to our communities and economy. 

Simply put, health insurance coverage helps people stay healthy, working, and out of debt – which helps our economy thrive. Tennesseans count on this coverage, so these tax credits need to stay in place for our neighbors and our collective future.