Culture, Medicine, and Psychiatry

, Volume 41, Issue 1, pp 161–180

“They Treat you a Different Way:” Public Insurance, Stigma, and the Challenge to Quality Health Care

  • Anna C. Martinez-Hume
  • Allison M. Baker
  • Hannah S. Bell
  • Isabel Montemayor
  • Kristan Elwell
  • Linda M. Hunt
Original Paper

DOI: 10.1007/s11013-016-9513-8

Cite this article as:
Martinez-Hume, A.C., Baker, A.M., Bell, H.S. et al. Cult Med Psychiatry (2017) 41: 161. doi:10.1007/s11013-016-9513-8


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.


Stigma Insurance Poverty Healthcare Medicaid Intersectionality 

Funding information

Funder NameGrant NumberFunding Note
Michigan Department of Community Health
  • 134355

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of AnthropologyMichigan State UniversityEast LansingUSA
  2. 2.Harvard T.H. Chan School of Public HealthHarvard UniversityBostonUSA
  3. 3.Department of Sociology and AnthropologyUniversity of Texas at ArlingtonArlingtonUSA
  4. 4.Center for Health Equity ResearchNorthern Arizona UniversityFlagstaffUSA

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