Share Your Story to Close the Health Insurance Coverage Gap

Thank you for sharing your story of being in the coverage gap with the statewide Care4Carolina coalition. Such accounts bring this important issue to life with a persuasive power that statistics alone just can’t muster. To help us tell your story, please respond to these quick questions. WE WILL KEEP THIS INFORMATION CONFIDENTIAL until we speak w/ you about how you’d like proceed: 

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Name *
Birthdate *
MM
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DD
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YYYY
City/town of residence *
Zip code *
Preferred Phone Number
Email
How does (or did) your living and/or working situation affect your ability to obtain health insurance? *
What are the biggest challenges (health or other) that you face in the coverage gap?  *
What would leaving the coverage gap --i.e. securing health insurance -- mean to you?  What would you be able to do that you cannot do now?  *
Tell us more about your health story *
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