The envelopes began arriving in December across eastern Kentucky, one of the sickest and poorest corners of the country. "Dear member . . . We want you to be healthy . . ." read the letter to Mary Combs, and with it came a plastic card representing the first insurance she ever had: a Medicaid plan made possible by the nation's new health-care law, effective Jan. 1. Nine days into the new year, the 41-year-old call-center worker headed to the health clinic on Highway 15. She saw a doctor about her chronic stomach ulcers, had her blood drawn for tests and collected referrals for all the specialists she had been told she needed but could never afford.