Karen Samborski is her husband’s translator. She speaks for him when he can’t find the words. She helps him understand when people are talking too fast. In church, she takes notes on the sermon so her husband, Mike, can read and understand.
“He calls me his interpreter,” she says.
It’s not that Mike doesn’t speak English. He can read, write, and speak just fine. But Mike has receptive aphasia, a brain condition resulting from a stroke in the fall of 2013. The aphasia means Mike’s brain has trouble interpreting others’ speech. “A lot of times, it goes to writing things down,” Karen says.
Mike was a landscape designer and stone mason and owned his own business, but after the stroke he couldn’t go back to work, and Karen had to leave her work in retail management to help care for him. In the fall of 2014, Karen and Mike moved from Massachusetts to Lebanon, TN to live with Karen’s twin sister and her husband until they could get back on their feet.
In Massachusetts, Mike had been receiving speech therapy through the state’s Medicaid program. Karen and Mike thought he’d be able to get help in Tennessee, too. Karen tried to research coverage options for Mike before they moved, but information was scarce. “It was unsettling to move down here and hope it all falls into place,” Karen said.
After they arrived, Mike applied for TennCare. They waited months for a decision, but no one they talked to could tell them whether Mike would be eligible. Finally, Mike was turned down.
Confused, Karen called the Tennessee Justice Center for help. Even though Mike had been determined disabled by the Social Security Administration, he was still in the two-year waiting period for Medicare and was not eligible for any health insurance in Tennessee. Tennessee’s Medicaid program (TennCare) is much more restrictive than in Massachusetts.
To make matters worse, they were not eligible for assistance to buy coverage on HealthCare.gov. Mike and Karen were in the coverage gap. “It was shocking to come down here and find it was totally different,” Karen said. “I was just so disappointed. I saw how well he responded to speech therapy back home. I saw what an improvement it made.” Karen was even more devastated to learn that Insure Tennessee, a plan that would have provided coverage to people in her and Mike’s situation, had failed in the state legislature.
“It’s a loved one’s health.” Karen said. “Why do we have to put a price on that?”
Staff at the Tennessee Justice Center explained the complex policy and political situation that had left her and her husband behind. TJC also found a way to get them coverage: if Karen took a part-time job, she and her husband would have enough income for assistance on the Marketplace, and she could still be home part time to care for Mike. TJC connected Karen with a health insurance Navigator, who helped her select a plan.
When Mike’s Medicare finally started, TJC connected them with a Medicare advocate to find a plan covering speech therapy. And when tax issues about their home in Massachusetts threatened to complicate their coverage, TJC worked with the Legal Aid Society to answer her questions. Because of TJC’s efforts, Mike and Karen are now out of the coverage gap. While they still have health care challenges, they have both been able to see a primary physician.
Mike said, “I’ve been very lucky to have had my wife with me through this whole time and still helping. This stroke has been rough for both of us. In some ways we are closer now than before even though we’ve always been there for each other. Having insurance has lifted a heavy burden off of our shoulders.”
For her part, Karen is glad she can help Mike navigate the world. “This was part of our wedding vows,” she says. “We took a vow: in sickness and in health.”
For her dedication and advocacy on behalf of her husband, TJC celebrates Karen as a Wife of the Year.