Roughly 25.3 million adults in the United States are currently uninsured, according to KFF’s analysis of the uninsured population — and a significant portion of them are working, paying taxes, and genuinely unsure whether any public program applies to them. Nadine Bianchi was one of those people. She just didn’t know it yet.
I first came across Nadine in January 2025, during a segment on WESA, Pittsburgh’s public radio station, about the confusion surrounding health coverage options for low-wage workers. She had called in during the live broadcast — not to ask a question, exactly, but to describe a feeling. “I just wanted someone to tell me I wasn’t crazy for not knowing what I was supposed to do,” she said on air. I tracked her down through the station’s listener contact form the following week and asked if she’d be willing to talk. She agreed, though she made clear she wasn’t proud of where she found herself.
When I sat down with Nadine Bianchi at a diner on the South Side of Pittsburgh on a cold February afternoon, she arrived early and ordered coffee before I got there. She’s 53, widowed since 2020, and has managed a small home goods boutique in the city’s Lawrenceville neighborhood for nearly eight years. She is the kind of person who apologizes before she finishes a sentence.
A Store Manager Without a Safety Net
The boutique where Nadine works — she asked me not to name it, to protect her relationship with her employer — does not offer health insurance. It never has. For years, that didn’t feel like an emergency. Her husband had been covered through his job at a local HVAC company, and she had been on his plan. When he died of a cardiac event in October 2020, that coverage ended within months.
What followed was a patchwork of avoidance. Nadine told me she skipped annual checkups, delayed a follow-up on a thyroid issue her doctor had flagged in 2019, and started buying over-the-counter substitutes for a prescription she’d been on for years. “I just kept telling myself I’d figure it out next month,” she told me. “And then next month became a year, and then it became longer than that.”
By 2023, Nadine was earning approximately $34,000 a year. She looked at the ACA marketplace that fall and found that plans in her area — even subsidized ones — ran between $280 and $410 per month for a silver-tier policy, with deductibles above $3,000. She didn’t enroll. As the boutique’s sales slipped through 2024, her income followed. By late that year, she was bringing home closer to $21,200 annually — a number that, as she would eventually learn, placed her squarely within Pennsylvania’s Medicaid eligibility range.
She had no idea. And nobody had told her to check.
The Moment She Picked Up the Phone
Nadine told me the radio call happened almost by accident. She was driving home from a closing shift in early January 2025 and heard the WESA segment playing on her car radio. A benefits counselor was explaining Pennsylvania’s Medicaid expansion under the Affordable Care Act. “She said something about 138 percent of the federal poverty level, and I thought — I don’t even know what that means for me,” Nadine recalled. “So I called in. I didn’t even know I was going to until I was already dialing.”
That assumption — that work, even low-wage work, disqualified someone from Medicaid — is one of the most persistent misconceptions in public benefits. Pennsylvania expanded Medicaid in 2015 under the ACA, extending eligibility to adults earning up to 138 percent of the federal poverty level. For a single adult in 2025, that threshold was approximately $20,783 per year, according to the Pennsylvania Department of Human Services. Nadine’s income in late 2024, once her hours had been cut, was slightly above that — but only briefly. A formal income recalculation put her within range.
The embarrassment Nadine described wasn’t just about not knowing the rules. It ran deeper than that. Her two adult children — a son in Denver, a daughter in Nashville — didn’t know she had been uninsured. Neither did her friends. “I wasn’t going to bring it up at book club,” she said, and offered a short, dry laugh. “It’s not exactly something you volunteer.”
Navigating Pennsylvania’s Medicaid System
After our first conversation, Nadine agreed to let me follow her application process in real time. She began by calling the statewide COMPASS hotline — Pennsylvania’s benefits portal — in mid-February 2025. The call took 47 minutes. She was asked to verify income, household size, residency, and citizenship status, and was told she would need to submit documentation including her most recent pay stubs, a copy of her lease agreement, and a bank statement.
The process was not seamless. Nadine told me she received a request for a second form of lease verification — her landlord’s signature on a supplemental form — that she hadn’t anticipated. “I almost gave up at that point,” she said. “I thought, if they’re going to make it this hard, maybe it’s not worth it.” She didn’t give up. She called her landlord, got the form signed, and resubmitted within 48 hours.
Pennsylvania’s standard processing window for Medicaid applications is 45 days, according to the PA Department of Human Services. Nadine’s took 27 days from submission to approval — faster than she expected, slower than she needed.
What the Coverage Actually Means — and What It Doesn’t Fix
When I spoke with Nadine again in early April 2025, the week her coverage had officially begun, she was matter-of-fact about it. She had already scheduled a primary care appointment and was working on getting a referral to address the thyroid issue that had gone unmonitored since 2019. There was relief in her voice, but it was measured.
But Medicaid doesn’t address everything that has gone sideways in Nadine’s financial life. She has no retirement savings — none. The boutique offers no 401(k), and the years after her husband’s death were spent stabilizing her household, not building a nest egg. She is 53. She described this part of our conversation with a flatness that was harder to listen to than anything else she said.
Medicaid covered what it was designed to cover. The broader picture — the retirement gap, the declining store revenue, the years of deferred medical care — those are problems that a single program approval letter cannot resolve. Nadine knows this. She said it plainly, without self-pity.
There is also the question of continued eligibility. Medicaid coverage in Pennsylvania requires annual renewal, and eligibility is recalculated based on current income. If the boutique’s revenue recovers — or if Nadine changes jobs — her income could shift above the threshold again. She would then need to transition to marketplace coverage during a special enrollment period. As she put it, “I feel like I’m always one piece of good news away from losing the thing I just got.”
What Reporting This Story Left Me Thinking About
I’ve covered public benefits for long enough to recognize when someone is describing a structural failure rather than a personal one. Nadine Bianchi is organized, articulate, and clearly capable of navigating bureaucracy once she knows she’s supposed to try. The 14 months she spent uninsured weren’t the result of negligence. They were the result of a system that doesn’t clearly communicate who it’s for.
The federal government estimates that roughly 2.2 million adults who are eligible for Medicaid are not enrolled, according to data referenced by Healthcare.gov. The reasons are varied — stigma, confusion about eligibility, distrust of government programs, or simply never having been told to check. Nadine embodied all of those reasons in a single 47-minute phone call.
When I left the diner that February afternoon, Nadine was still sitting with her second cup of coffee. She said she had a few more minutes before she needed to head to the store for an afternoon shift. She looked tired in the way that has less to do with sleep and more to do with years of carrying something quietly. Getting a Medicaid card in the mail didn’t change what she was carrying. It just meant she could finally go see a doctor about it.
Leave a Reply