Low premiums here are striking because residents of Hamilton County, where Chattanooga is located, are more likely to be obese, smoke and suffer from hypertension than average, according to the Institute for Health Metrics and Evaluation, a Seattle-based research center. Yet premiums here are comparable to some of the nation’s healthiest regions: Minneapolis, Salt Lake City, and Honolulu, where less demand for medical services allows for the nation’s least costly policies.

Though Chattanooga’s lowest-cost silver plan is built around the well-regarded Erlanger Health System, some new buyers are upset that the number of doctors is limited and their personal physicians are not included—even though that is a primary reason the premium is so low. Others view their new policies as adequately priced but nothing special. Still others who had been covered through a state program, where they only paid a third of the premiums, consider their new rates high in comparison.

Brian Taylor, a 36-year-old private investigator who had been uninsured, said he bought a $132 a month bronze plan with a $4,000 deductible because it was less expensive than being added to his wife’s employer-provided policy. “It’s probably a decent price, I guess, for what it covers,” said Taylor, who noted that he supported the insurance changes in the health law.

Limiting Coverage to One Hospital

Erlanger is a public health system with the region’s only academic teaching hospital. Erlanger also has the only high-level trauma center and neonatal intensive care unit in the area, so it can handle nearly all patient needs, said Henry Smith, the BlueCross executive who negotiated the contract.

“For the most part, they’ve got everything,” said Henry Smith, BlueCross’s chief marketing officer. “We have backfill providers to make sure we have no services uncovered.”

Some employers who have examined the variety of offerings in Chattanooga’s market said they are impressed. “In all honesty, the insurance is good and the premiums are outstanding,” said Philip Bryan, who owns a Georgia textile manufacturing company that employs many Tennesseans.

Bryan said before this year, few of his employees had enrolled in the insurance he offered because of the expense: about $1,700 a person or $3,400 a family a month. “That’s basically unaffordable insurance,” he said. “We went out and looked at what it would be on the Affordable Care Act [exchange] and how much it would be, and it was truly amazing. Anything we saw was low. I told my people there’s no reason for anybody here not to be insured.”

Bryan added half the cost of the marketplace premiums into workers’ paychecks and helped them sign up for coverage on those exchanges. Most of his workers—like 80 percent of Tennesseans who enrolled—qualified for taxpayer subsidies. “I only have one or two people who opted out of the thing,” he said.