“They Treat you a Different Way:” Public Insurance, Stigma, and the Challenge to Quality Health Care
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Under the Affordable Care Act, Medicaid Expansion programs are extending Medicaid eligibility and increasing access to care. However, stigma associated with public insurance coverage may importantly affect the nature and content of the health care beneficiaries receive. In this paper, we examine the health care stigma experiences described by a group of low-income public insurance beneficiaries. They perceive stigma as manifest in poor quality care and negative interpersonal interactions in the health care setting. Using an intersectional approach, we found that the stigma of public insurance was compounded with other sources of stigma including socioeconomic status, race, gender, and illness status. Experiences of stigma had important implications for how subjects evaluated the quality of care, their decisions impacting continuity of care, and their reported ability to access health care. We argue that stigma challenges the quality of care provided under public insurance and is thus a public health issue that should be addressed in Medicaid policy.
KeywordsStigma Insurance Poverty Healthcare Medicaid Intersectionality
The Michigan Department of Community Health (MDCH) provided funding for this research project (Grant # 134355). The views in this paper are those of the authors, and should not be assumed to reflect those of MDCH.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study. All names have been changed to pseudonyms and identifying information has been removed.
- Ablon, Joan 1981 Stigmatized health conditions. Social Science and Medicine 15B:5-9.Google Scholar
- Barr, Barbara Matacera 2000 Stigma: A Paper for Discussion. Covering Kids National Program Office, Southern Institute on Children and Families.Google Scholar
- Bird, Sheryl Thorburn, and Laura M. Bogart 2000 Perceived race-based and socioeconomic status (SES)-based discrimination in interactions with health care providers. Ethnicity and Disease 11(3):554-563.Google Scholar
- Crenshaw, Kimberle 1989 Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum 1989(1):139-167.Google Scholar
- DelVecchio Good, Mary-Jo, et al. 2003 The Culture of Medicine and Racial, Ethnic, and Class Disparities in Healthcare. In Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare. B.D. Smedley, A.Y. Stith, and A.R. Nelson, eds. Pp. 594-625. Washington, D.C.: The National Academies Press.Google Scholar
- Gaines, Atwood D. 2005 Race: Local Biology and Culture in Mind. In Companion to Psychological Anthropology: Modernity and Psychocultural Change. C. Casey and R. Edgerton, eds. Pp. 255-278. Oxford: Blackwell.Google Scholar
- Goffman, Erving 1963 Stigma: notes on the management of spoiled identity. New York: Simon and Schuster.Google Scholar
- Jackson, Pamela Braboy, and David R. Williams 2006 The intersection of race, gender and SES: health paradoxes In Gender, race, class, and health: intersectional approaches. Pp. 131-162. San Francisco, CA: Jossey-Bass.Google Scholar
- Kaeser Family Foundation, Kaiser Commission on Medicaid and the Uninsured 2013 Medicaid: A Primer-Key Information n the Nations’ Health Coverage Program for Low-Income People, Vol. 2016. Kaeser Family Foundation.Google Scholar
- Levinson, Arik, and Rahardja Sjamsu 2004 Medicaid Stigma. Washington D.C., Georgetown University.Google Scholar
- Piatak, Jaclyn S. 2015 Understanding the Implementation of Medicaid and Medicare Social Construction and Historical Context. Administration & Society. doi: 10.1177/0095399715581030.
- Quadagno, Jill 2015 The Transformation of Medicaid from Poor Law Legacy to Middle-Class Entitlement In Medicare and Medicaid at 50: America’s Entitlement Programs in the Age of Affordable Care. A.B. Cohen, D.C. Colby, K.A. Wailoo, and J.E. Zelizer, eds: Oxford University Press.Google Scholar
- Silow-Carroll, Sharon, et al. 2001 Community-Based Health Plans for the Uninsured: Expanding Access, Enhancing Dignity. Battle Creek, MI: W.K. Kellogg Foundation.Google Scholar