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NASHVILLE — The number of Tennesseans with no health insurance climbed to its highest level in six years in 2019, according to a new University of Tennessee report.

Affordability is cited as a key factor for the now-estimated 468,096 uninsured adults and children without health coverage in the annual survey conducted by UT at Knoxville's Boyd Center for Business and Economic Research for the state's TennCare health insurance program.

Those Tennesseans now account for 6.9% of the state's total population of 6.77 million, according to the study. It's a 17,469-person increase representing a 3.64% bump over last year's estimate, which pegged the then-uninsured rate at 6.7%.

While the 2019 estimate represents a slight increase over last year's uninsured rate, it is the state survey's highest estimate since 2014 when 472,008 people were said to have no health coverage. And it's nearly 100,000 more than a 2015 survey, which marked a sharp decline among the uninsured.

Eighty-one percent of those surveyed this year cited that they "cannot afford" coverage as the major reason behind not having it. Another 8% cited affordability as a minor reason for their situation.

This year's survey comes amid a continuing state debate over the impacts of a drop-off in enrollment in TennCare, the state's version of the Medicaid health insurance program for 1.4 million low-income children, their caretakers, pregnant women, seniors and the disabled.

At the same time, Gov. Bill Lee, who took office in January, is now seeking, under the direction of fellow Republicans in the legislature, a controversial federal waiver of Medicaid rules. And that's roiling advocates for the poor, enrollees and at least some health care providers.

Among other things, the Boyd Center 2019 survey of some 5,000 heads of households found that for kids age 18 and under, the percentage of uninsured children in Tennessee rose 24% over 2018 to 42,749, an 8,021-child increase. It shows 2.8 percent are uninsured. Last year's figure was 34,458 which represented 2.3%.

The Boyd Center conducts the survey annually for the state's TennCare Division and it also includes a section on how satisfied TennCare enrollees are with their coverage. The report says that for the uninsured, "affordability continues to be a major hindrance to obtaining health insurance."

"The biggest sector of the population that was affected were the children," said Dr. LeAnn Luna, a professor with the Boyd Center, who spearheaded the survey and report. "They had the largest decline [in coverage]."

While coverage for adults ticked down two tenths of one percent, children were "more like half a percent," Luna said.

"The trends we are seeing in Tennessee are consistent with nationwide trends," Luna said. "You are seeing similar responses in other states."

Michele Johnson, executive director of the Tennessee Justice Center, said Tennessee's "historic growth in the uninsured, including being No. 1 in the nation in the growth of uninsured kids, is not an act of God. It's the result of a series of deliberate and harmful political decisions and unchecked future-crushing bureaucracy gone wild."

She said the state's "leadership failures will have lasting impacts on real Tennesseans for generations."

Tennessee is one of just 13 states that have refused to expand their Medicaid programs under the federal Affordable Care Act. Advocates say accepting the federal money would insure an additional 300,000 adult men and women.

TennCare's effort to move its computers into the modern age were plagued by problems for several years as a result of what TennCare officials said was their then-contractor's inability to get its proposed new system working correctly. As a result, the state was forced to resort to paper forms.

The Justice Center and others say a number of enrollees wound up getting lost and disenrolled.

After hiring a new contractor who completed work on a new system, the state this year announced it is able to handle applications and renewals. State officials also argue that a healthy economy has also led to fewer people needing TennCare.

Agency spokeswoman Sarah Tanksley dismissed Johnson's criticisms as "just wrong. It's never been easier to apply for or keep your TennCare or CoverKids coverage. The only thing you have to do is make one phone call to 855-259-0701."

That's also "true for the people that have left the programs in recent years," Tanksley said. "If they are, in fact, eligible, all they have to do is make one phone call and they can regain coverage."

TennCare continues to provide high-quality, cost effective care to its members, Tanksley said, alluding to a survey question that found 76% of heads of households with TennCare said their coverage was "good" or "excellent."

Last month, the U.S. Census Bureau estimated that in 2018, another 46,000 Tennesseans — 0.6 percent — had no health coverage, raising federal officials' estimated total to 675,000, or just over one in every 10 people in the Volunteer State without insurance.

Tennessee was tied with Alabama and Arizona for having the nation's third largest percentage increase in uninsured people, according to the U.S. Census Bureau estimates.

The Tennessean, meanwhile, reported last week that U.S. Census Bureau estimates for 2018 now show 83,000 Tennessee children that year had no health insurance.

While Tennessee defines children as age 18 and under, the Census Bureau uses age 19 and under. It wasn't immediately clear what other methodology differences there may be other than measuring different time periods.

Contact Andy Sher at asher@timesfreepress.com or 615-255-0550. Follow him on Twitter @AndySher1.

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