County-Level Data on Tennessee’s 2018 Obamacare Enrollment

Last week, we dug into statewide data on 2018 open enrollment in private health insurance through the healthcare.gov Marketplace created by the Affordable Care Act (ACA).  The maps, charts, and tables below show how key data about 2018 Marketplace enrollment vary by county.

The following observations were notable in our analysis of the data, but the factors that might be driving them are not yet clear:

  • Counties in Northeast Tennessee experienced the largest declines in enrollment from 2017 to 2018.
  • The average net premium for subsidized enrollees is notably higher in the rating areas that include Davidson County and the Tri-Cities. Meanwhile, these same areas have some of the lowest premiums for the minority of enrollees who are unsubsidized.

Note: These county-level data are based on actual enrollment and plan selections during the 2018 open enrollment period that ran from November 1st to December 15th, 2017. Participating insurers, plan options and premium rates are based on 8 “rating areas” across the state, which are shown on the maps that follow.

Enrollment

  • Tennessee’s most populous counties (i.e. Davidson, Shelby, Knox, and Hamilton) have the most enrollees. Just under 229,000 Tennesseans enrolled statewide in Marketplace coverage for 2018. (Figure 1)
  • Enrollment ranges from 1.8% of population in Montgomery County to 5.1% in Sevier County. Statewide, Marketplace enrollment amounts to about 3.4% of the state’s total population. (Figure 2)
  • Change in enrollment from 2017 to 2018 varies considerably — ranging from a 7.6% increase in Williamson County to a 14.6% decline in Hawkins County. Statewide enrollment was relatively stable with only a 2% drop from 2017. (Figures 3 and 4)

Figure 1

2018 Enrollment in Tennessee's Healthcare.gov Marketplace, by County (Map)

Figure 2

2018 Enrollment in Tennessee's Healthcare.gov Marketplace, by County (Bar Chart)

Figure 3

2017 to 2018 Change in Enrollment in Tennessee's Healthcare.gov Marketplace, by County (Map)

Figure 4

2017 to 2018 Change in Enrollment in Tennessee's Healthcare.gov Marketplace, by County (Bar Chart)

Subsidies

  • The share of enrollees eligible for federal subsidies to offset premiums ranges from 66% in Williamson County to 97% in Decatur County. Statewide, about 84% of enrollees are eligible for federal premium subsidies. (Figures 5 and 6) These subsidies are available to those with incomes under 400% of poverty (about $48,560 for an individual in 2018).
  • Average monthly premium subsidies range from $569 in Williamson County to $1,082 in Perry County, while growth in subsidies from 2017 to 2018 range from 21% in Bledsoe County to 95% in Loudon County. Statewide, average premium subsidies for eligible enrollees were $797 per month, a 51% increase over average subsidies in 2017. (Table 1, bottom of page) Because subsidies are available on a sliding scale, growth in average premium subsidies is driven by both premiums for the “benchmark” plan on which subsidies are based and the income levels of actual enrollees.

Figure 5

Percentage of 2018 Tennessee Healthcare.gov Marketplace Enrollees with Premium Subsidies, by County (Map)

Figure 6

Percentage of 2018 Tennessee Healthcare.gov Marketplace Enrollees with Premium Subsidies, by County (Bar Chart)

Premiums

  • There is a wide range across counties in average monthly premiums for both subsidized and unsubsidized enrollees.
  • Subsidized enrollees’ net average monthly premiums range from $12 in Haywood County to $74 in Cheatham and Johnson Counties. Statewide, this average amount is $39 per month, on average. (Figures 7 and 8)
  • Unsubsidized enrollees’ average monthly premiums range from $514 in Davidson County to $1,007 in Houston County. Statewide, this average amount is $619 per month. (Figures 9 and 10)

County-level data on 2017 premiums are not available, which limits our ability to do county-level analysis of premium trends.


Figure 7

2018 Average Net Monthly Premium for Subsidized Enrollees in Tennessee's Healthcare.gov Marketplace, by County (Map)

Figure 8

2018 Average Net Monthly Premium for Subsidized Enrollees in Tennessee's Healthcare.gov Marketplace, by County (Bar Chart)

Figure 9

2018 Average Monthly Premium for Unsubsidized Enrollees in Tennessee's Healthcare.gov Marketplace, by County (Map)

Figure 10

2018 Average Monthly Premium for Unsubsidized Enrollees in Tennessee's Healthcare.gov Marketplace, by County (Bar Chart)

Table 1

Tennessee 2018 Healthcare.gov Marketplace Data by County

2018 Marketplace EnrollmentEnrollment as a % of 2017 Population2017 to 2018 Change in Enrollment% of 2018 Enrollees with Premium SubsidiesAvg. Premium Subsidy2017 to 2018 Change in Avg. Premium Subsidy2018 Avg. Net Monthly Premium - Subsidized Enrollees2018 Avg. Net Monthly Premium - Unsubsidized Enrollees
2018 Marketplace EnrollmentEnrollment as a % of 2017 Population2017 to 2018 Change in Enrollment% of 2018 Enrollees with Premium SubsidiesAvg. Premium Subsidy2017 to 2018 Change in Avg. Premium Subsidy2018 Avg. Net Monthly Premium - Subsidized Enrollees2018 Avg. Net Monthly Premium - Unsubsidized Enrollees
Tennessee228,6463.4%-2.3%84%$79751%$39$619
Anderson County2,3963.1%0.5%84%$88379%$25$722
Bedford County1,4082.9%-7.7%89%$95134%$28$763
Benton County5443.4%-4.9%93%$1,01636%$22$866
Bledsoe County3682.5%3.4%93%$97621%$20$820
Blount County4,4013.4%-8.1%86%$88187%$28$699
Bradley County3,6383.4%-0.3%92%$87531%$22$700
Campbell County1,0612.7%0.5%90%$95880%$18$736
Cannon County4743.3%-1.5%92%$86533%$24$770
Carroll County8723.1%-0.8%93%$99330%$20$872
Carter County1,6152.9%-13.3%92%$72755%$63$656
Cheatham County1,3423.3%-4.2%83%$69144%$74$650
Chester County5113.0%-3.4%91%$94632%$21$732
Claiborne County1,0283.3%1.6%89%$93077%$19$639
Clay County3674.8%-3.2%95%$88936%$21$828
Cocke County1,1793.3%-8.7%92%$1,00981%$29$840
Coffee County1,7293.1%-1.8%93%$95135%$26$796
Crockett County5263.6%-8.5%92%$95334%$13$813
Cumberland County2,0443.5%3.3%92%$92434%$27$741
Davidson County30,9944.5%5.7%77%$57440%$62$514
Decatur County4974.2%-3.3%97%$98931%$23$960
DeKalb County6713.4%-2.8%93%$89836%$26$721
Dickson County1,8313.5%-4.1%90%$94634%$27$759
Dyer County1,2243.3%-0.2%92%$94833%$15$821
Fayette County1,3943.5%0.6%82%$91184%$35$768
Fentress County6833.8%6.4%94%$87433%$23$729
Franklin County1,2653.0%-6.9%91%$94830%$31$740
Gibson County1,5713.2%-4.7%92%$94829%$19$730
Giles County1,0473.6%-4.1%92%$99535%$19$894
Grainger County7653.3%-1.7%92%$98082%$18$838
Greene County1,8282.7%-10.6%92%$73855%$73$603
Grundy County5253.9%0.2%93%$1,00827%$20$801
Hamblen County1,8952.9%-2.0%90%$91383%$24$730
Hamilton County14,0963.9%-1.1%88%$82229%$26$674
Hancock County2273.4%-9.2%94%$828n/a*$57$543
Hardeman County8173.2%-2.7%94%$95530%$16$765
Hardin County9563.7%-1.7%92%$1,01833%$20$683
Hawkins County1,3732.4%-14.6%91%$76155%$72$636
Haywood County4872.8%-6.0%85%$97582%$12$755
Henderson County1,1414.1%0.5%95%$92033%$17$772
Henry County1,1823.6%2.8%92%$1,01634%$17$765
Hickman County9213.7%-7.0%94%$98933%$23$902
Houston County2022.5%3.6%95%$99324%$34$1,007
Humphreys County4822.6%-7.8%94%$96132%$25$772
Jackson County4603.9%-7.1%94%$95737%$16$919
Jefferson County1,8193.4%-5.5%88%$93482%$31$722
Johnson County4222.4%-8.1%91%$77556%$74$621
Knox County17,8563.9%-7.7%81%$81987%$33$631
Lake County1482.0%-2.0%93%$1,008n/a*$17$681
Lauderdale County5262.1%-7.6%91%$92779%$20$757
Lawrence County1,8324.2%1.4%95%$97433%$16$715
Lewis County4553.8%-8.5%93%$1,01529%$19$867
Lincoln County1,4534.3%1.4%94%$96134%$21$750
Loudon County1,7613.4%-4.5%83%$93695%$35$722
McMinn County1,5943.0%3.8%92%$91129%$24$716
McNairy County8893.4%0.5%93%$95529%$14$805
Macon County8073.4%-1.3%92%$88633%$23$673
Madison County3,5103.6%-3.1%89%$90134%$20$715
Marion County8683.1%-2.7%91%$94730%$28$756
Marshall County9022.7%-6.4%92%$94531%$26$804
Maury County3,1233.4%-1.6%89%$89133%$27$741
Meigs County3462.9%-3.1%94%$94526%$21$745
Monroe County1,3733.0%-2.8%90%$97779%$24$781
Montgomery County3,6471.8%3.1%84%$63138%$61$545
Moore County1973.1%-4.8%94%$97936%$23$842
Morgan County4151.9%-1.0%86%$99081%$27$673
Obion County9033.0%1.8%95%$96530%$18$813
Overton County8463.8%-1.1%95%$87229%$17$828
Perry County2763.5%2.2%94%$1,08233%$17$759
Pickett County2114.2%-7.5%94%$93136%$30$729
Polk County5903.5%3.0%95%$96129%$23$869
Putnam County3,0453.9%-0.8%92%$78935%$23$620
Rhea County8292.5%-3.0%92%$93829%$23$819
Roane County1,3422.5%-13.8%86%$92486%$25$827
Robertson County1,9322.8%1.8%83%$65939%$72$593
Rutherford County8,3052.6%-6.6%82%$59643%$60$523
Scott County5902.7%-11.0%91%$93889%$22$598
Sequatchie County5713.9%5.7%92%$92229%$25$625
Sevier County4,9615.1%-4.6%88%$89785%$30$704
Shelby County30,3403.2%-4.9%79%$82080%$28$669
Smith County6563.3%0.5%93%$88833%$20$815
Stewart County4183.1%-2.3%91%$1,01834%$23$718
Sullivan County4,6262.9%-13.4%89%$70556%$68$615
Sumner County5,4833.0%2.0%80%$62942%$69$552
Tipton County1,4652.4%-1.2%87%$86084%$33$758
Trousdale County2162.1%-7.7%88%$71839%$66$632
Unicoi County4952.8%-12.2%92%$76656%$68$722
Union County6073.1%-0.7%91%$96583%$35$728
Van Buren County2294.0%5.5%93%$94531%$17$752
Warren County1,3743.4%-1.1%93%$87637%$24$678
Washington County4,2823.4%-10.0%87%$66860%$67$590
Wayne County7344.4%-2.3%96%$1,01633%$16$727
Weakley County7822.3%-4.6%93%$94629%$22$926
White County1,1424.3%1.0%94%$86732%$18$780
Williamson County9,0874.0%7.6%66%$56944%$67$519
Wilson County4,3293.2%3.1%79%$64641%$68$549

*Average premium subsidy data for 2017 are unavailable for Hancock and Lake Counties.
Note: Based on plan selections during the 2017 and 2018 open enrollment periods.
Sources: The Sycamore Institute’s analysis of data from the 2018 Marketplace Open Enrollment Perioid State- and County-Level Public Use Files and the U.S. Census Bureau (3) (4) (1) (2) (3)


Related Work by The Sycamore Institute

Tennessee’s 2018 Obamacare Enrollment
(April 13, 2018) Analyzes statewide data on 2018 Marketplace enrollment and premiums.

CSR Payments, Uncertainty, and Tennessee’s 2017 ACA Marketplace
(September 29, 2017) Analyzes 2018 Marketplace premiums and explains cost-sharing reduction payments and what they might mean for Tennessee.

Health Insurance Markets 101 – Key Concepts that Influence Access and Affordability
(April 5, 2017) Discusses key health insurance terms and concepts that influence insurance access and affordability (e.g. risk pooling)

Health Insurance Coverage in Tennessee in 2016
(October 5, 2017) Analyzes the most recent data on the rate of the uninsured and where insured Tennessean’s get health coverage.

Click here for all Affordable Care Act (ACA)-related posts by The Sycamore Institute.

References

  1. Centers for Medicare and Medicaid Services. 2018 Marketplace Open Enrollment Period State-Level Public Use File. U.S. Department of Health and Human Services. [Online] April 3, 2018. [Accessed on April 4, 2018.] Accessed via https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/2018_Open_Enrollment.html.
  2. —. 2018 Marketplace Open Enrollment Period County-Level Public Use File. U.S. Department of Health and Human Services. [Online] April 2018. [Accessed on April 17, 2018.] Accessed via https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/2018_Open_Enrollment.htm.
  3. —. 2017 Marketplace Open Enrollment Period State-Level Public Use File. U.S. Department of Health and Human Services. [Online] May 11, 2017. [Accessed on April 4, 2018.] Accessed via https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/Plan_Selection_ZIP.html.
  4. —. 2017 Marketplace Open Enrollment Period County-Level Public Use File. U.S. Department of Health and Human Services. [Online] May 11, 2017. [Accessed on April 17, 2018.] Accessed via https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Marketplace-Products/Plan_Selection_ZIP.html.
  5. U.S. Census Bureau, Population Division. Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2017 . [Online] March 2018. [Accessed on April 17, 2018.] Accessed via https://factfinder.census.gov/bkmk/table/1.0/en/PEP/2017/PEPANNRES/0400000US47|0400000US47.05000.