The Reality of the Coverage Gap

Clara Clark is a resident of Montgomery County, Tennessee, where she spends her days in charge of toddlers, “Clarksville’s cutest residents,” she says. Ms. Clara moved to Clarksville three years ago, following her daughters from California. She couldn’t live in California without them. Now, she’s forced to choose to be near her family or have affordable healthcare.

In California, Ms. Clara worked in the aerospace field—testing the brakes on planes, helicopters, and utility plants. She even worked on the Indiana Jones ride at Disneyland! “I had the best insurance in California,” says Ms. Clara. She even had a procedure that would have cost her $65,000, but she only paid $20 out of pocket.

Ms. Clara spent her entire life insured until she moved to Tennessee. Ms. Clara grew up on California’s Medicaid system, MediCal. When she moved to Tennessee to be with her family, she didn’t realize what she would have to give up. She applied for a marketplace plan, thinking it would work until she turned 65 and would qualify for Medicare.

That was, until the premium tax credits expired.

At the beginning of 2026, the enhanced premium tax credits expired, and millions of American’s premiums skyrocketed, leaving many unable to afford healthcare. Ms. Clara is one of those people. Her premium went from $150 to $650 per month. At 63 years old, Ms. Clara decided she will go uninsured until she becomes eligible for Medicare at age 65. Ms. Clara is one of the millions of working-class people that are falling into the coverage gap all over the country.

Since going uninsured, Ms. Clara goes to her local health department to get her blood pressure medications. She’s relatively healthy now, but if she does get seriously ill or injured, she has to drive 90 minutes into Nashville to get care at the Vanderbilt charity care program. “People all over Clarksville do the same thing,” says Ms. Clara. “They would rather risk driving across counties to get charity care than go to the local hospital.”

Ms. Clara wonders how many people, like herself, move to Tennessee and find themselves in a similar situation: “I would have never left California had I known about the healthcare system in Tennessee. I know I can’t be the only one. I’m a working person, I’ve been working basically my whole life, and now I’m at a crossroads. I’m not asking for anything free, I’m just asking for something in between. All I’m asking for is something I can get a grip on.”