Commentary Health Systems

On Medicaid, Shame, and Not Being Silent


Shame is a powerful cultural and political tool that has been used to keep people from accessing the resources they need. Shame has kept my name anonymous in this article, but it will not stop me from accessing health care, telling this story, or encouraging others to do the same.

This piece is published in collaboration with Echoing Ida, a Strong Families project.

When the Obamacare exchanges became open for enrollment this fall, I eagerly went online to check out my options for affordable health care in my state. It was exciting to know that I could potentially afford health insurance. I considered how my life would be affected: doctors’ visits, blood tests, checkups, an eye exam, a teeth cleaning—all the things I’ve longed for as an uninsured adult.

After wading through a sea of questions about my income and expenses to determine my eligibility, I discovered what I had not considered a possibility:

I qualify for Medicaid.

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Wow. Am I that poor? For so long I made just enough money to not qualify for Medicaid. Now, I do qualify.

While I was relieved to know I wouldn’t need to pay out-of-pocket each month for health care, I felt uncomfortable. I had originally intended to write about my experiences navigating Obamacare, how I’m weighing the options or different health-care plans in my state. But how was I going to write about that now? I couldn’t possibly share my experiences navigating Medicaid in public.

My initial thoughts and feelings were rooted in shame. I didn’t want people to know my income is so low that I qualify for Medicaid. I still don’t. that’s why this piece is being published anonymously: I can’t bear the thought of my name being tied to this story. But I am writing this piece, because it needs to be written. Shame has bought my anonymity, but it hasn’t bought my silence.

Shame is a tool. It keeps people immobilized, silent, and afraid. It keeps people in closets, in hiding, invisible.

Shame is discreet. Using EBT cards only when you go to the grocery store alone because you don’t wanted be outed about receiving food stamps. Using cash when you’re food shopping with friends or acquaintances who don’t know how you usually pay for your groceries. Being vague about what you do for a living because you’re on unemployment insurance while you pursue your dreams. Writing anonymous articles about navigating Medicaid because you don’t want the public to know you’re on a publicly subsidized program.

Contrary to the popular mythology of the “welfare queen” living lavishly and unapologetically on public assistance, some of us do not feel a sense of entitlement to use the programs for which we qualify. Part of this comes from an otherization of welfare—“Oh no, I’m not one of those people” or “I don’t want people to think—or know—I’m one of them.” This is an internalization of the public shaming of the safety net.

And I’m sure this is only one of the reasons why nearly 700,000 people nationwide who qualify for Medicaid haven’t enrolled in the program.

Money and time is spent to keep the “welfare queen” mythology alive, not only informing budget cuts, but also the minds of people who qualify for public assistance but decide not to use it. Shame is ridiculous. It will have you believe you deserve nothing—that you don’t deserve the resources you qualify for, resources that can support your livelihood.

Still, the truth of the matter is that the economic climate of the United States has made public assistance widely used. People are working jobs they’re overqualified for, and underpaid to do, to make ends meet, and they still need publicly subsidized programs to hold it all together. The use of programs like SNAP (the Supplemental Nutrition Assistance Program, commonly known as food stamps), Medicaid, and unemployment insurance are not uncommon among my peers—a generation of college-educated, upwardly mobile folks using public assistance.

Ultimately, I am moving forward with my application for Medicaid. I want health care and have gone long enough without it. Shame will not pay for my medical bills, exams, prescriptions, or my well-being. For me, the question has become: How do I discuss the process of accessing Medicaid in public, online? In the past, I haven’t had a problem strategically using my personal experiences to leverage critical analyses of systemic policy problems and cultural dilemmas. But in this case, I am unwilling to go there. This is not a past-tense situation I triumphantly overcame, outgrew, or no longer need. This is now. And I am unwilling to pay the cost of my public vulnerability. To be Black, female, poor, and visible is not respectable; it is, in fact, dangerous.

Tanya Fields, a pregnant unwed mother of four children and the executive director of the BLK Projek, spoke up during the bell hooks and Melissa Harris-Perry conversation at the New School in New York City last month. She spoke about how she has been shamed and silenced because of the number of children she has as an unmarried Black woman. And she faced serious backlash for speaking up about the respectability politics she was experiencing in her community. She has been told that her motherhood and marital status are her personal business, not to be discussed in public places. She has been called names. She has been told that she is what’s wrong with the Black family. And she still has an organization to run and a family to take care of.

While Fields’ experiences are not with Medicaid, they are telling of what is at stake for a Black woman speaking publicly about the truths of our life circumstances that do not fit neatly into respectability—the truths that expose us to potential public shaming, stereotyping, and scapegoating.

The work of increasing health coverage is also to remove the stigmatization of publicly subsidized programs. Shame is a powerful cultural and political tool that has been used to keep people from accessing the resources they need. Shame has kept my name anonymous in this article, but it will not stop me from accessing health care, telling this story, or encouraging others to do the same. Audacity is the first step in dissolving shame, and I intend to be courageous.

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