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."