I’ve never lived in poverty. We came pretty close for a while this year when my hours were drastically reduced at work, but even then my income never dipped for any sustained period below the thresholds for us to qualify for public assistance. I guess you could say I’ve seen the back of poverty’s head, but never met it face to face.
In spite of our decent income, my daughter has Medicaid until her eighteenth birthday because she came to me from the foster care system. I have insurance but her coverage is far better than mine: Medicaid pays for everything. Doctor visits, prescriptions, dental, vision – all are completely covered. And we’ve had very little problem finding qualified doctors who accept Medicaid (though dentists are another story).
Usually I’m thrilled that she has Medicaid, but there are times when I hate it. Because having a child on Medicaid often means tolerating disrespect, even contempt, from medical professionals and the staff in their offices.
See here’s the thing: most children on Medicaid have the coverage because their families are having a tough time financially. The physical effects of poverty could fill a whole diary (or diary series), and I’m thankful to have never experienced them first hand. But the contempt with which many members of society treat the poor is something I have experienced because of my daughter’s Medicaid. When I pull out her insurance card, the treatment I receive deteriorates as providers slot me into certain stereotypes. It doesn’t always happen, but it happens often enough to identify a pattern.
Stereotype 1: My daughter has Medicaid because I’m poor. There’s no shame in being poor; this is one is hurtful primarily because it triggers all the rest, which are stereotypes about poor folks.
Stereotype 2: I’m a deadbeat. This is the stereotype that brings us constant attempts to slash public assistance programs: people on public assistance are there because they are lazy, aren’t trying, are happy to take advantage of you the taxpayer. For the record, I know two of my daughter’s friends who also received Medicaid. One parent lost his job due to an illness and hasn’t been able to find another that his health will allow him to do. The other, a single Mom, works two jobs but still doesn’t earn a living wage.
Stereotype 3: I am stupid and/or ignorant. Since I have the private insurance, I can clearly see the difference in how medical providers and their staff treat me when I’m seeking care for myself compared to when I’m seeking care for my daughter. The differences in how I’m addressed – tone of voice, attitude, word choice - are often striking.
Stereotype 4: I’m unreliable. From confronting one provider, I know the origin of this one. You’ll be shocked to learn that poor families often have problems with dependable transportation and communication. So it may be that the poor are more likely to miss appointments without calling than the rest of us (I'm not saying it is true, just that I can see how it might be).
But is it necessary to tell me the penalties for missed appointments repeatedly, in a condescending manner, and threaten me in advance with all sorts of penalties, when I’ve never missed one? This has happened to me on a couple of occasions with my daughter’s care, but strangely with my own care a routine written notice among the other paperwork was sufficient.
Stereotype 5: I’m a neglectful parent. I recently took my 13-year-old daughter to the local Urgent Care for an injury, the result of youthful exuberance gone wrong. I realize I could prevent such injuries; perhaps I should have her stay in the house texting, playing on the computer and watching TV all day – that would make me a better parent, right?
That recent visit to Urgent Care was the final straw that triggered this diary. That day I saw it all. After we signed in, I was called back and told there would be a delay because they couldn’t get through to the Medicaid computer to verify her coverage. Fair enough, but was it necessary to actually say: “We need to verify every visit because people with Medicaid aren’t very good at doing what Social Services requires to keep coverage”? And by tone and mannerism suggest, “and you’re probably one of those people”?
Then we met the doctor, who implied that I didn’t supervise my daughter well enough, the nurse who talked to me like I was a fool when giving me the follow-up care instructions and the administrator who stressed three times the penalty if we missed her follow-up appointment without calling. All this left me wondering whether a provider who looks down on us so disrespectfully can really feel we are worthy of their best quality of care.
Now I know that some of this is hard to nail down: the disrespect is often subtle (though sometimes not so subtle). Attitude, tone of voice, and word choice are hard to convey in writing and it’s impossible to prove that this happens because she has Medicaid. But as I’ve said, I see the contrast between how I’m treated when I present my Blue Cross card compared to when I present her Medicaid card, and it’s sometimes pretty shocking.
When I told this story to the mother described above who works two jobs to support her three kids and is Hispanic, she just said. “Try it with brown skin, an accent AND Medicaid.”
Unfortunately, I bet I’d be shocked yet again.