40-year-old Liver Transplant Recipient Depended on ACA Marketplace Enhanced Premium Tax Credits to Afford His Recovery

Client's name has been changed for privacy and anonymity  

After years of caring for others as a registered nurse in Hardeman County, Tennessee, 40-year-old Mr. Smith suddenly found himself on the other side of the hospital bed. In early 2025, he underwent major heart surgery and a liver transplant. Following his surgery, Mr. Smith spent two months in the Intensive Care Unit under close monitoring and three weeks in a pulmonary rehab facility, followed by another one and a half weeks in a general rehab facility. As a transplant recipient, Mr. Smith’s medical needs are extensive. Specialized surgeries, frequent hospital visits, and ongoing routine lab work are all part of his recovery. 

Mr. Smith lost his employer-sponsored health insurance when he had to stop working to undergo surgery and begin recovery. Thankfully, he qualified for TennCare, Tennessee’s Medicaid program, during his hospital stay. The coverage was short-lived. Not long after being discharged, while still managing pain and a growing list of medications, Mr. Smith received a devastating notice: his TennCare was ending. The timing couldn’t have been worse. Without health insurance, the cost of post-transplant care would be overwhelming. A missed lab test or delayed prescription could put his recovery at risk.  

In desperation, Mr. Smith reached out to the Tennessee Justice Center for help. After screening his situation, TJC connected him with Get Covered Tennessee, whose staff helped him enroll in a new health plan through the Affordable Care Act (ACA) Marketplace without a gap in coverage. “It was a blessing,” he recalls. With that support, “[I] found a plan that worked well enough, and it was very affordable.” 

Mr. Smith receives Enhanced Premium Tax Credits (EPTC) that lowers his monthly premium by an astounding $700, making comprehensive coverage affordable even on his limited Social Security Disability income. For Mr. Smith, the impact goes beyond dollars and cents: “It has provided peace of mind that I don’t have to worry about a major bill coming.” 

Introduced in 2021, EPTC have significantly reduced out-of-pocket costs for millions of ACA Marketplace enrollees. These enhanced subsidies have helped fuel record-high Marketplace enrollment across the country. According to KFF, enrollment in Tennessee alone increased by a remarkable 221% from 200,445 enrollees in 2020 to 642,867 enrollees in 2025. The data tell a clear story: People want health insurance coverage. EPTC make it possible to afford it. 

Mr. Smith is grateful to policymakers but urges them to stay grounded in the real-life experiences of their constituents: “First, thank you for working to try to take care of our public. Listen to the public’s opinion because that is why we elected you. Listen to the public’s opinion, not just your own.” In states like Tennessee who haven’t expanded Medicaid, EPTC are often the only pathway to coverage. If EPTC are not extended, Marketplace costs will surge and thousands will be kicked off of their plan. 

Reach out to your congressional representative using TJC’s EPTC Sign-On Letter and share the facts and talking points about how expiring EPTC may affect you or your community. 

Client's name has been changed for privacy and anonymity