XPost: ba.politics, dc.media, soc.penpals   
   XPost: alt.burningman   
   From: aca@horror.com   
      
   NASHVILLE, Tenn. -- The day Linda Drain put baby's breath in her   
   hair and said "I do," she had no idea that government policies   
   would tear her apart from her husband.   
      
   But 33 years later, she and her husband, Larry Drain, separated   
   so she could keep her health insurance.   
      
   Six months into the full implementation of the Affordable Care   
   Act, the Drains are among 162,000 Tennesseans who got caught in   
   a coverage gap. Their household income is too little to qualify   
   for a government subsidy to buy health insurance, and they live   
   in a state not expanding Medicaid.   
      
   Their predicament was caused by a series of legal, political and   
   bureaucratic decisions that included the U.S. Supreme Court   
   striking down part of the federal health law, but Larry Drain   
   said he feels to blame.   
      
   "In September of last year, I made what looking back on it in   
   retrospect was the worst decision I ever made in my entire   
   life," he said. "I decided to take early retirement from Social   
   Security."   
      
   Even though his monthly benefit was significantly less than the   
   paycheck he had been bringing home, the decision changed the   
   eligibility requirements for Linda Drain to continue receiving   
   Supplemental Security Income. If she kept living with her   
   husband, she would lose SSI eligibility, which would make her no   
   longer qualify for TennCare, the state's Medicaid program.   
      
   Linda Drain has epilepsy. She has suffered so many seizures she   
   has damaged the nerves in her back. She has spinal stenosis, a   
   condition aggravated by the titanium in her back. Despite having   
   undergone brain surgery to alleviate the seizures, she still has   
   to take expensive medications to prevent them.   
      
   She cannot do without insurance. So she has either lived with   
   her mother in Alcoa or stayed in a homeless shelter in Knoxville   
   since the separation to avoid hitting the household income limit.   
      
   Meanwhile, Larry Drain lives alone in the small apartment in   
   Maryville they once shared, making do without insurance and   
   hoping the hernia he can't afford surgery for won't cause a   
   bowel obstruction.   
      
   They got caught in the health care cracks created by the U.S.   
   government and the state of Tennessee. Had the federal   
   government's income guidelines been different, she would not   
   have lost her SSI or they might have qualified for subsidies to   
   help them buy insurance on healthcare.gov. Had Tennessee   
   expanded its Medicaid program, they both would have been   
   eligible for coverage.   
      
   Every day, Larry Drain writes a letter to Tennessee Gov. Bill   
   Haslam asking him to expand Medicaid and posts it on a blog.   
      
   "In some ways, it is like a virtual sit-in," he said. "I   
   couldn't go sit in his office, but in some way I need to say, 'I   
   am here. I am going to be here. I'm going to talk about things   
   you don't want talked about.'"   
      
   The Tennessee Plan   
      
   Behind the scenes, officials within the Haslam administration   
   have been talking with federal officials about how Tennessee   
   might qualify for Affordable Care Act federal funds to cover   
   poor, uninsured people. But the governor ruled out expanding   
   Medicaid in March 2013 and said he favored a plan to leverage   
   federal funds to, instead, help the poor buy private health   
   insurance. Haslam said then that a "Tennessee Plan" should   
   require copayments so people would have "some skin in the game."   
      
   "Governor Haslam believes that more people having access to   
   health care is a good thing, but you have to do it in a way that   
   controls costs and provides for better outcomes," said Dave   
   Smith, press secretary for Haslam.   
      
   The Affordable Care Act allows the federal government to pick up   
   the full cost of insuring new people who qualify for Medicaid   
   under the expanded guidelines through 2016. It will then phase   
   down to a permanent 90 percent matching rate in 2020.   
      
   But members of Tennessee's Republican-controlled legislature are   
   wary of the federal promises and worry that Tennessee can't   
   afford the 10 percent match the state would have to start   
   providing. Tennessee tried Medicaid expansion once before in the   
   1990s, then had to scale back and force people off the program   
   because of cost overruns.   
      
   Even without Medicaid expansion, the Affordable Care Act offers   
   subsidies to Tennessee couples making more than $15,510 to help   
   buy insurance on the federal exchange. But couples like Larry   
   and Linda Drain who make less than that get nothing. The federal   
   health law intended for the poorest people who were uninsured to   
   obtain coverage through Medicaid expansion, but the U.S. Supreme   
   Court took the teeth out of that part of the law, leaving the   
   decision up to the states.   
      
   In Tennessee and most Southern states, couples who make less   
   than $15,510 and individuals who make less than $11,490 are out   
   of luck in getting any type of help toward obtaining health   
   coverage.   
      
   Unfair, uninformed   
      
   It's a situation that Americans are beginning to recognize as   
   unfair, according to a poll released by HealthPocket, an online   
   service that helps consumers compare insurance plans. In the   
   South, half of poll participants answered that the Medicaid   
   coverage gap was unfair, compared with 19 percent who believed   
   it was fair. The others said they didn't understand the issue.   
      
   "The number of people who didn't understand the issue was very   
   surprising," said Gav Coleman, head of research and data at   
   HealthPocket. "You're talking one out of three people."   
      
   Across the South, nearly 4 million uninsured people fall into   
   the same coverage gap as Larry and Linda Drain, according to a   
   Kaiser Family Foundation report. In Tennessee, they account for   
   24 percent of uninsured, non-elderly adults.   
      
   Larry Drain said he didn't have insurance at his last job.   
      
   "The irony of it was I was working full time at a hospital with   
   no benefits," he said. "When I got the job, what they explained   
   to me was the hospital was losing money hand over fist because   
   of uncompensated care."   
      
   He worked most of his life in social work and counseling. Linda   
   Drain said she tried to work but couldn't get hired or would get   
   fired when employers found out about her seizures.   
      
   Special moments 'ripped away'   
      
   The couple did not know she would be at risk for losing her SSI   
   and TennCare when he retired at age 62.   
      
   "We had it figured out that between what I got from retirement   
   and from what she got from SSI that we would never be rich," he   
   said. "We would basically always be below the poverty level —   
   but we could live. We could pay our bills and have a little bit   
   left over and we would do fine."   
      
   But two months later they got a call from Social Security. He   
   tried to reverse his decision, he said, but that would have   
   required reimbursing the checks he had received — money that had   
   already been spent on rent, food and gas.   
      
   "After one or two months of crying and lots of prayers and lots   
   of yelling and screaming, on Dec. 26 — after 33 years of   
   marriage — we separated," Larry Drain said.   
      
   Now, they live about 2 miles apart, but they don't see each   
      
   [continued in next message]   
      
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