Posted 10/16/19

(Editor's Note: This is the seventh in a series exploring poverty in Bradley County and the Ocoee Region, as well as the growing number of local families struggling to survive as the "working …

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(Editor's Note: This is the seventh in a series exploring poverty in Bradley County and the Ocoee Region, as well as the growing number of local families struggling to survive as the "working poor.") 


Christina Albornoz-Gravell and her husband make a combined $74,000 a year to support themselves and their three children at home; yet, they’re stretched thin and unable to pay for repairs around the house due to the astronomical cost of health care. 

Gravell said they pay premiums on plans through work, and their family has to meet a $3,000 deductible before the insurance will cover any claims. Paying out of pocket in co-pays in addition to putting money toward a health savings account, Gravell said her family has only met that premium twice in 12 years. 

The cost of healthcare and lack of coverage under health insurance is a large hurdle for the ALICE (Asset Limited, Income Constrained, Employed) population, and something that keeps them in the cycle of financial vulnerability. 

The United Ways of Tennessee used national and statewide data to create Survival and Stability budgets, which can be found in the United Way ALICE report. In these budgets, individuals making enough to meet the determined cost of living pay approximately $124 a month on health care, while a family of four pays around $539 a month. 

Even in the United Way Stability Budget, the costs barely change — $128 for individuals and $609 for families. 

Gravell attributed the Affordable Care Act (ACA) as a main contributing factor to the rising expense of health-care premiums, stating that her family’s health care was “affordable before Obamacare was passed.” 

With the introduction of the ACA in 2014, Tennessee has seen a reduction in uninsured low-income households, but an increase in premiums offered in the healthcare marketplace over the last year. The ALICE report states that while these low-income households have access, they are still less likely to have coverage over households with a higher annual income. 

According to the report, “many ALICE families fall into a critical gap in health insurance coverage: They often earn more than Medicaid eligibility, but not enough to afford the high deductibles of the lowest-cost Affordable Care Act plans.” 

For an elderly individual, their out-of-pocket expenses may invite debt they will never pay off in their lifetime. 

President and CEO of the United Way of the Ocoee Region Matt Ryerson described a friend of his, Nancy, who suffered a fall on the way out to the mailbox and broke her ankle. 

In her 80s, Nancy’s broken ankle led to surgery, which led to rehab and physical therapy, resulting in a bill “she can’t pay off until she’s 119,” Ryerson said. 

Still, Nancy pays $25 a month on her limited income toward the medical expense. 

A paycheck-to-paycheck lifestyle takes its toll mentally and physically, as well.


Debbie Millard, a single mother and grandmother in Cleveland caring for three generations of her family on one paycheck, said she gained 90 pounds since receiving custody of her two grandsons over a decade ago. She said the lack of funds limited her ability to purchase healthy food, resulting in stress from the budget strain and a poor diet as well. Now, she faces additional costs from doctors' visits due to the stress and weight gain. 

The ALICE report says “poor mental and physical health are both a cause and a consequence of being low-income.”

“The stress of financial hardship can have a range of effects, from fatigue and depression to increased risk of heart disease — and those health problems, in turn, can further compromise work attendance, earnings and income.” 

With her children at home, ages 10, 12 and 17, Gravell has found that health insurance and dental insurance “cover less and less each year.” 

“I’ve got one that needed braces because his teeth started coming in sideways. Even though teeth can impact your health, that’s covered under dental insurance, and that’s a totally separate thing,” she said.

Now in her 40s, she said braces as a teenager cost $1,500 out of pocket, with $1,500 covered by dental insurance. Today, her insurance provider covers the same cost, $1,500 of the bill, but her son’s braces cost over $6,000. 

The cost of health insurance and care prevents Gravell from taking care of much-needed home repairs, like window, floor and gutter replacements. Making well above the determined cost of living for a family of five, Gravell finds health care consuming the majority of their monthly income. 

“That is our highest expense and it never covers anything,” she said. “Pretty sad, I say. The pay today does not match the cost of living by any means.” 



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