The Crisis in Rural Healthcare
A Policy Briefing for Tennessee Leaders
The Situation at a Glance
Tennessee's rural communities face a deepening healthcare crisis, driven by financial strain and gaps in coverage. The data below highlights the most urgent challenges requiring immediate policy attention. Click each metric for more context.
Rural Hospitals Closed
16
Since 2010, placing TN highest in the nation for closures per capita.
In The Coverage Gap
245,000
Uninsured adults who earn too much for TennCare but too little for ACA subsidies.
Rural Uninsured Rate
10.6%
Significantly higher than the 9.9% uninsured rate in Tennessee's urban counties.
Core Challenges
Two intertwined issues drive the rural health crisis: a growing gap in insurance coverage and affordability, and the accelerating decline of local providers and facilities. Explore the data behind these challenges below.
The Widening Coverage Gap
Tennessee is one of ten states that has not expanded Medicaid, creating a "coverage gap." An estimated 245,000 uninsured Tennesseans, many in rural areas, fall into this gap. Their incomes are above the state's strict TennCare eligibility limits but below the federal poverty level, making them ineligible for subsidized ACA Marketplace plans.
This problem is set to worsen. Enhanced ACA subsidies, which made coverage affordable for over 380,000 Tennesseans, will expire after 2025 without congressional action. This would lead to an average premium increase of 93% for subsidized enrollees, pushing coverage out of reach for thousands more and further straining rural economies.
Actionable Solutions
Addressing this crisis requires decisive, evidence-based policy action. The following proposals represent the most effective strategies to stabilize rural healthcare, improve health outcomes, and ensure economic vitality for communities across Tennessee.
The Single Most Impactful Step: Provide additional appropriations to TennCare and ACA subsidy eligibility to reduce the number of uninsured Tennesseans.
- Economic Benefit: Creates jobs and stimulating local economies.
- Hospital Stability: Provides a critical financial lifeline to struggling rural hospitals by reducing uncompensated care costs, the primary driver of closures.
- Improved Health: Ensures access to preventive care, chronic disease management, and life-saving treatments, leading to a healthier, more productive workforce.