Navigating Blurred Borders: Keeping Jobs and Using TennCare across State Lines

In the last forty years, living wage employment opportunities for individuals without post-secondary education have steadily declined throughout the United States (di Leonardo 2008, Fletcher 2016). When manufacturing jobs began leaving the United States in the 1980s and 1990s, living wage careers were replaced by service industry jobs. Service industry workers are frequently given part-time status, which offers low pay, few benefits, and unpredictable shift rotations (Durrenberger 2007). Limited access to healthcare resources, irregular work schedules, and economic insecurity all significantly impact long-term health and wellness (Mullings 2002, Geronimus 1992). There are three major metropolitan areas in East and West Tennessee that share borders with one or more neighboring states. Memphis, Chattanooga, and the Tri-Cities all provide employment opportunities and healthcare options for residents living in rural communities in neighboring states. Residents in these states frequently work in Tennessee cities and use healthcare resources provided by Tennessee’s public sector healthcare program TennCare, while continuing to live in neighboring states with lower costs of living. Based on interviews conducted in 2010-2011 and 2013-2015, this paper investigates two lines of inquiry guiding new exploratory research in East Tennessee 1) What decisions do low-wage workers make in order to maintain their health at work? and 2) What strategies do working poor people employ in order to secure employer or state based healthcare resources in Tennessee?

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