A deal to extend enhanced tax credits for the Affordable Care Act (also known as Obamacare) was one of the things holding up a resolution to the federal government shutdown.
Ultimately, the record-breaking shutdown ended with congressional Republicans and Democrats’ agreement to vote on the matter in January, following the December expiration of the credits. Senate Democrats want to extend the credits, while Republicans do not.
The costs were already locked in for those who use the Affordable Care Act marketplace at healthcare.gov, a service for those who don’t receive workplace insurance and don’t qualify for TennCare, Tennessee’s form of Medicaid. The open enrollment period lasts from Nov. 1 to Jan. 15 each year.
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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.”
All of the ACA plans, which were instituted in 2010, are subsidized by the federal government based on the user’s income. Enhanced 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. The insurance companies anticipated the expiration of these credits this year, so they upped the premiums, explains Michele Johnson, CEO of local health advocacy organization Tennessee Justice Center.
“The insurance companies made the judgment based on the fact that the premium subsidies had not been extended that the only people who will make sacrifices to stay on health insurance will be those people who know they have really expensive health care needs,” Johnson tells the Scene.
Aida Whitfield, program director of the Healthcare Access Program at Family & Children’s Service in Nashville says she’s seen clients’ monthly premiums as much as double or triple. But there’s another wrinkle: Due to federal funding cuts, the health care navigation staff at her organization was slashed from 37 people to just four. That means fewer people to help those in need access ACA coverage.
“It definitely impacted a lot of people,” Whitfield says of the enhanced tax credits. “It definitely supported a lot of people to be able to have insurance and have regular checkups done on top of their health care needs. This time, it’s very discouraging. People are opting out to not having insurance or opting out to just having a bare minimum of insurance in case of emergency but are not able to use it as much as they want or they need.”
Tennessee saw an uptick in ACA enrollees during the 2024-25 open enrollment period (627,797) compared to the 2023-24 open enrollment period (521,347). During the 2023-2024 enrollment period, Tennessee saw a 49.8 percent jump from the previous enrollment period. At the time, this change was attributed to a loss of coverage due to TennCare’s unwinding process, improved outreach and cheaper costs than in years prior due to the additional tax credits. Tennessee has a larger uninsured population than many other states, as one of just nine that has not expanded Medicaid. This means adults younger than 65 who don’t have a child or a disability do not qualify for TennCare.
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Next year, we’ll know how many people didn’t come back to the ACA marketplace because of the higher costs, Whitfield points out. But it’s harder to measure whether people will forgo treatment and preventative care because they may no longer have insurance or are on a high-deductible plan.
One of the most common questions Whitfield gets: Will there be a refund later on in 2026 if the premium tax credits are reinstated? Whitfield can’t answer that one — it remains to be seen. It is also unclear how President Trump’s idea to give money in a Health Savings Account-style manner would impact the ACA or work in practice.
“If, in fact, the subsidies pass, and we have a lot of healthy people signing on and signing up, it’s possible they’ll get rebates and get some of that money back,” says Tennessee Justice Center’s Johnson. “But it’s not possible — and I wish it were — that the insurer would come back and say, ‘Actually, the premiums are going to be less.’ It’s too late.”
