Despite continued flux in the commercial and Medicare Advantage markets, BlueCross BlueShield of Tennessee remains the largest insurer and is a leader in payment reform and health innovation programs. Lower or flatlining premiums in 2021 for both commercial and Medicare Advantage residents could increase medical and associated drug utilization as Tennessee battles high rates of chronic disease. Despite efforts to manage and coordinate care for a great number of Tennesseans, many remain in the coverage gap, and future healthcare for these individuals remained murky under the previous administration. Since many residents lost their employer coverage due to the pandemic, off-exchange commercial enrollment decreased, while the insurers with the cheapest exchange plans (like Cigna) or expanded options (UnitedHealthcare rejoined the scene after a four-year pause) could see some uptake. As the nation seem to relax its COVID-19 restrictions, commercial enrollment saw a slight incline (Clarivate data). However with the Biden administration signing COVID-19 stimulus bill, Tennessee Republicans are now open to Medicaid expansion talks.