NASHVILLE, Tenn. — After more than a decade of steady gains, Tennessee is losing ground on health coverage, and a new policy brief warns that the most recent numbers probably understate the shift.
The Sycamore Institute reported this week that 9.7 percent of Tennesseans had no health insurance in 2024, up from 9.2 percent a year earlier. That works out to about 691,000 people, an increase of roughly 36,000. In 2010 the rate stood at 14.4 percent.
The bigger change may be happening now. ACA Marketplace sign-ups in Tennessee more than tripled, climbing from roughly 200,000 in 2020 to close to 643,000 by 2025, while enhanced federal premium subsidies were in place. Those subsidies expired at the end of 2025, and the number of Tennesseans who actually paid for Marketplace plans dropped by about 93,000, or 17 percent, between 2025 and 2026.
TennCare, the state Medicaid program, now covers about 1.36 million people, down from a pandemic-era high of nearly 1.8 million in 2023. Tennessee never adopted the Medicaid expansion under the Affordable Care Act, so most working-age adults without children or a disability cannot qualify on low income alone.
That matters because national data compiled by America’s Health Rankings show uninsured rates run higher in states that did not expand Medicaid, among lower-income people, among adults ages 26 to 34 and among adults who did not finish high school.
Inside Tennessee the gaps are wide. County rates in 2024 ranged from 4.4 percent in Williamson County to 17.2 percent in Bledsoe County, with rural counties higher on average.
The Sycamore brief is part of a series meant to frame choices for the next governor and General Assembly. It notes that federal estimates for 2025 are not out yet, so no one knows how many people who left the Marketplace found coverage elsewhere. A national Healthy People 2030 goal calls for raising the share of people with insurance.
Filed under: Bristol TN Health News
