Tennessee was an important site for several reasons: chief among them that, while the state was home to leading US health insurance companies, such as HCA Holdings, its politicians also continually blocked the ACA and Medicaid expansion for state citizens. Health insurance coverage rates thus remained low for many lower- and middle-income Tennesseans when compared to expansion states; health care coverage in many ways became an export product as a result. As of February 2017, seventy-three of ninety-five counties in the state had only one insurer offering health care plans, putting these
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