Healthcare at What Price? Understanding the Affordability Crisis
- TJC
- 2 days ago
- 4 min read
Across the country, Americans feel the healthcare affordability crisis. Emergencies are expensive for uninsured people, and even those who are insured face high costs for various treatments and prescriptions. In Tennessee, approximately 10% of the population is uninsured (700,000 people), 1.4 million people are on Medicaid, 600,000 are insured through the Affordable Care Act (ACA) Marketplace, and the rest are privately insured. Nearly three million Tennesseans—those uninsured, on the Marketplace, and on TennCare—have been implicated in the recent national conversation about access to healthcare following the passage of H.R.1 in July 2025 and the recent expiration of the enhanced premium tax credits (EPTCs), also referred to as health subsidies.
The Healthcare Value Hub at Altarum, funded by the Robert Wood Johnson Foundation, conducted its 2025 Consumer Healthcare Experience State Survey (CHESS) to evaluate an array of Tennessee respondents’ healthcare opinions. Their findings reflect that healthcare affordability is of pressing concern to Tennesseans across demographics.
In addition, Tennessee, like many other states, will face changes to its Medicaid program (TennCare) in the coming years. That is why healthcare affordability has been a prominent national message for campaigning Democrats in 2025, and the 2026 midterm elections are likely to see the same focus. Amidst extreme public pressure, the Republican party has also emphasized healthcare affordability despite slashing Medicaid through H.R.1 and opposing an extension of healthcare subsidies. As highlighted below, the CHESS briefs timely reveal that healthcare access and affordability are bipartisan issues affecting a wide range of demographics and that everyone is seeking a real solution. The fate of healthcare hangs in the balance of whether Congress will take action to revive the enhanced premium tax credits or offer comparable solutions to decrease the cost of healthcare for the average person. The release of the Tennessee-focused CHESS briefs explain how our state is impacted by the national healthcare affordability crisis.
72% of respondents delayed or went without healthcare due to affordability over the last 12 months, meanwhile 24% skipped a recommended medical test or treatment.
Over half (51%) of uninsured respondents cited the high cost of insurance as the primary reason they remained without coverage.
81% of respondents of color reported forgoing care due to cost in the past twelve months, compared to 68% of white alone, non-Hispanic/Latino respondents.
On average, people with a disability pay almost five times more annually for healthcare ($13,492) than a person without a disability ($2,853).
The majority of respondents (67%) reported having insurance at the time they incurred their medical debt.
Burdens are spread across the state with over two-fifths (45%) who reported experiencing one or more of these struggles to pay their medical bills in the last year:
16%—Used up all or most of their savings
15%—Were unable to pay for basic necessities like food, heat or housing
11%—Borrowed money, got a loan or another mortgage on their home
7%—Asked for donations (GoFundMe campaigns)
Households with lower incomes experience more healthcare affordability burdens than higher income households, but ALL households, regardless of income, experience such burdens.
Households that include a person with a physical/cognitive impairment experienced very similar health care affordability burdens to those without a physically or cognitively impaired person (i.e., able-bodied people have high healthcare costs as well).
Some respondents reported extensive burdens in search of quality care after a hospital merger: “The hospital that has taken over many clinics and local hospitals has horrible ratings and now we are driving up to 3+ hours away for quality treatment.”
Tennessee respondents believe that the reason for high healthcare costs is due to powerful industry stakeholders, such as:
73%—Drug companies charging too much money
70%—Hospitals charging too much money
69%—Insurance companies charging too much money
Across political affiliations, Tennesseans are largely in agreement that things need to change in the healthcare system.
Nearly 1 in 3 respondents (31%) reported rationing medication due to cost in the last year
Respondents earning less than $50,000 a year, those enrolled in TennCare, and respondents with a disability or who live with a person with a disability, reported rationing medication more frequently than other respondents.
Many respondents face multiple burdens which contribute to the reason begind rationing medication: “I have a rare bone disease that is supposed to be monitored annually by having a full body MRI. The cost of that for me is $1200 that I couldn’t afford so I have not had that test.”
There is bipartisan support for a variety of policies designed to make prescription drugs more affordable:
91% — Cap out-of-pocket costs for life-saving medications, such as insulin
91% — Set standard prices for drugs to make them affordable
91% — Prohibit drug companies form charging more in the U.S. than abroad
The expiration of health subsidies and the imminent changes to Medicaid (TennCare) will further increase the burdens detailed above. Altogether, it is very clear that Tennesseans agree on the importance of healthcare access and affordability.
For questions regarding data, please contact:
Beth Beaudin-Seiler, Beth.Beaudin-Seiler@altarum.org
Kiera Williams, Kiera.Williams@altarum.org
