On Medicaid, Shame, and Not Being Silent


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.

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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  • expect_resistance

    Thanks for writing this article. You’re right, there should be NO shame in accepting medicaid, or unemployment insurance, etc. Conservatives have waged war on the poor. They demonize, shame, and blame the poor.

    The gap between the which and the poor is getting bigger. Good paying jobs are becoming a thing of the past. I think this will become more of a reality for many of us. I know that our family income has gone down since 2008. We have been struggling to make it and are barely keeping afloat. I keep hearing that the recession is over and we are in a recovery. I say bull. I’m still living with the great recession like many others.

  • Joan2

    Because of where my parents lived, by chance, I was zoned to go to one of the best elementary schools in Alabama. It was the best because it drew students and tax dollars from some of the richest neighborhoods in our community. While that was good in many ways, I found it was very stigmatizing to be the poor kid. When I was in 5th grade, my grade school teacher announced that some kids in our class qualified for free lunches because our parents were poor. Then she proceeded to call out the names of the kids and I was beyond mortified when she called out MY name. I knew my parents were struggling, but until then I thought I wasn’t that much different form the other kids. I think I started crying right there in the classroom and later the teacher pulled me aside and apologized, but the damage was done. The other kids never treated me the same after that and some of my friends stopped playing with me. I think it added to the shame I already felt about going through early puberty. It was just another way I was different and not in a good way. I was so ashamed I refused to actually eat the free cafeteria lunches (which were cooked on-site, nutritious and delicious, by the way), and from then on, brought soggy sandwiches from home that I usually tossed in the trash without eating. From that day on, I had a hard time making friends and never really felt a part of my school peer group. How could my teacher have been so heartless and careless? This is the same teacher who made us pray every morning, and went around the classroom and asked each child where they went to church and invited them to come to the Baptist Church with her if she did not approve of their church… It’s just not right to put that kind of stigma on a little kid. I hope you’re burning in Hell, Mrs. Hyde!

    • http://littlemisshaldol.tumblr.com/ LittleMissMellaril

      That’s what conservative christians are like, they wanna apologize after they have said horrible things because they, “feel bad.” Whatever, saying sorry doesn’t change things.

    • CJ99

      That teacher is just the kind of shit flinger I often had in school. Mrs Gault will be bunkies with Mrs Hyde I don’t doubt. I had similar experences, being screamed at for nearl half an hour for asking to go to the bathroom, being screamed at again for spelling Lego with 1 G not 2 (the proper spelling is 1 G by the way).

  • http://www.kizi1.org/ Kizi 1

    you always bring the most interesting and wonderful, I love what belongs to you it’s very useful

  • CJ99

    Where I live a few years ago I found myself appling for disability support, heavily stress related so it doesn’t usually show as an obvious injury, what I soon realized is the so called support system itself is the problem, its infused with repuglican style “values” which is more concerned with “delivering value to taxpayers” (the creep who kept neglecting his job and avoided handling my claim for a full 3 years actually tried to say that at a hearing & was ignored by all) than actually doing the jobs they get paid for. The bitter irony is they’re well paid NOT to do their stated jobs. A lot of the shaming originates in the system itself to discourge those who really need it from using it. All for the benefit of the so called “case workers” who more often than not get bonuses for cutting costs (by cutting enrollment) than actually doing their stated jobs (at least what they tell the public).

    Btw, I have worked a lot of my life even from before graduating high school onwards and I have graduated college. Another irony the technical field I went into never paid a third of what those running these programs now earn for the most part.

  • SeaLioness

    I have a bachelor’s degree. I owned my own business. I have four kids. We have had Medicaid coverage for going on four years. Ironically, I qualified for Medicaid *while* I was working a management-level office job. Because the boss didn’t understand why he should give other people raises when HE hadn’t given himself a raise for 10 years.
    When my business failed, we went on food stamps. For months, I watched people eyeballing my food purchases. If I wanted to make an “illicit” purchase of seafood, organic produce, or anything that could be considered “gourmet”, I went late at night to a store that had self checkout. Anything to hide from those horrible people who follow other shoppers through the parking lot to retrieve their receipt, take a picture, and post it on Facebook along with a nasty comment.
    Being an educated person on public assistance is a strange experience. But I don’t hide anymore. There is no shame in feeding my children and making sure our family is as healthy as possible — the three months it took us to get approved for food stamps were the most terrifying of my life. If you’ve never experienced food insecurity, you will never NEVER understand.

    • http://littlemisshaldol.tumblr.com/ LittleMissMellaril

      I once wanted to make my Mom a cake for her birthday while on food stamps, they said food stamps did not cover the decoration icing. As far as I am concerned, You do not know if that meal is for a special occasion or not!

      But when these people need food stamps, well, how dare you criticize them!