Roughly one in ten Americans under 65 has no health insurance — and that number climbs sharply among people who work contract or gig-based roles where employer benefits simply don’t exist. Dianne Womack, 34, was one of them for fourteen months.
I found Dianne in late February 2026 through a call-for-sources I posted on social media, asking to hear from people navigating government benefits without a clear path forward. Her reply was short: “I work in IT, I should have figured this out by now, but I haven’t. I just don’t know where to start.” That honesty was exactly what I was looking for.
When I sat down with Dianne — over a video call on a Tuesday evening, her youngest audible in the background asking for a snack — she walked me through her situation with the flat tone of someone who has rehearsed the details so many times they’ve stopped carrying weight. “I’m not panicking anymore,” she told me. “I’m just tired of it.”
A Family of Five With No Coverage and a Leaking Roof
Dianne works as a contract IT project manager in Nashville, Tennessee, bringing in about $41,000 a year. Her husband Marcus works retail at an hourly wage of roughly $26,000 annually. Their combined household income is approximately $67,000 — decent-sounding on paper, but stretched thin across a blended family of five.
The household includes three children: Dianne’s two daughters from her first marriage, ages 8 and 11, and Marcus’s son from a previous relationship, age 9. The family has been together just over two years — long enough to feel settled, Dianne said, but not long enough to feel financially stable.
Neither Dianne’s contracting agency nor Marcus’s retail employer offers health benefits. Her previous salaried position — where she had full employer-sponsored coverage — ended in January 2025 when the company downsized and eliminated her department. Since then, she, Marcus, and all three children have had nothing. Fourteen months and counting.
“I kept telling myself I’d figure it out next month,” she said. “But then the car needed work, then the roof started leaking, and ‘next month’ just kept moving further away.”
Tennessee’s Coverage Gap Is Not a Myth
Tennessee is one of a small and shrinking number of states that has declined to expand Medicaid under the Affordable Care Act. TennCare — the state’s Medicaid program — covers adults with dependent children only at income levels around 105% of the federal poverty level. For a family of five in 2026, that ceiling sits at roughly $39,900 per year. Dianne and Marcus earn well above it.
That places her family in what health policy researchers call the “coverage gap” — earning too much for Medicaid, but without understanding the ACA marketplace subsidy system, assuming they earn too little to afford anything meaningful elsewhere. Dianne had assumed she simply didn’t qualify for any help.
As Dianne explained, she had visited HealthCare.gov once, about eight months prior, and immediately closed the window when she saw a family plan listed at $890 a month before subsidies. “I just assumed that was the real price,” she told me. “I didn’t know there was a completely different number after the credits were applied.”
The ER Visit That Forced Her Hand
In October 2025, Dianne’s 8-year-old fell off a scooter near their driveway and needed stitches on her chin. What should have been a routine urgent care visit became a $1,240 out-of-pocket bill, paid in four installments that Dianne described as feeling like “a punch every single time” the automatic payment cleared.
That October visit was the turning point. In November 2025, during open enrollment, Dianne used HealthCare.gov’s subsidy estimator for the first time and discovered that her family qualified for premium tax credits based on their projected 2026 income. A silver-tier plan for all five family members came out to approximately $387 per month after estimated credits — a number she had never thought possible.
What She Found — and What It Still Does Not Solve
Dianne enrolled in a marketplace plan in December 2025, with coverage starting January 1, 2026. The monthly premium settled at $394 after her estimated tax credits — less than her car payment. She described the enrollment process as “brutal but doable” once she understood what she was looking at.
The plan carries a $6,500 individual deductible and a $13,200 family out-of-pocket maximum. For a household already running on fumes, those numbers feel enormous even in the presence of a plan. “We have insurance now,” she said, “but if something serious happened, I genuinely don’t know how we’d pay the bills on top of the premiums.”
The roof — a section of flashing that failed during a rainstorm last August, leaving water stains across the ceiling of the master bedroom — remains unrepaired. Dianne has collected three bids ranging from $7,800 to $9,200 but hasn’t been able to commit to any of them. She found a county-run home repair assistance program through Metro Nashville’s housing office, applied in September 2025, and was told the waitlist runs at least eight months.
The Weight of Going Through the Motions
What struck me most about talking with Dianne wasn’t frustration or anger — it was the absence of both. She described a $1,240 ER bill, a leaking roof, and fourteen months without coverage for three children with the same detached steadiness someone might use to describe a delayed bus. She is not defeated. She is numb.
According to the Social Security Administration, federal benefit programs exist to provide financial protection across all of life’s journeys — but navigating the gaps between those programs, especially in states with restrictive Medicaid rules, can leave working families stranded between the systems designed to help them.
Dianne told me she only recently discovered that Tennessee’s CoverKids program — the state’s Children’s Health Insurance Program — carries higher income thresholds than TennCare for adults, and that her three children might qualify separately. If they do and she moves them off her marketplace plan, her monthly premium could drop to somewhere around $180. She is currently working through the application. “There’s always another form, another system, another thing I didn’t know existed,” she said.
When I asked what she would tell someone in her exact position — contract worker, no employer benefits, kids in the house — she paused for only a moment. “I’d tell them to just open the website. Not to wait until the ER forces you. Because that’s what I did, and it cost me money I didn’t have.”
She said it without urgency. Just as a fact — the way she says most things now. For Dianne Womack, the goal is not to get ahead. It is to stop falling further behind. In March 2026, that’s exactly where she is: enrolled, insured, and still staring at a leaking roof she can’t afford to fix.
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