Public health insurance, which includes both Medicare and Medicaid, covered 34.4% of the American population in 2018. Even with those numbers, there’s still a strong stigma against receiving public health coverage.
Unfortunately, this stigma keeps millions of Americans from seeking — and receiving — the health care they need. People aren’t willing to go to the doctor because they have to admit they use Medicaid or Medicare, and they feel shame about it.
We must educate Americans about Medicaid and the wide-ranging positive impact the program has and work to remove the stigma around public health coverage.
The Difference Between Medicare and Medicaid
Medicare and Medicaid are both public health programs, but there are important differences. The most significant distinction is that Medicare is a federal program that is the same nationwide. Medicaid is state-based, and the coverage can vary depending on where you live.
Medicare has supplemental programs that help people fill in the gaps and gain additional benefits. For instance, Medicare Advantage plans can provide dental, vision, and prescription medication coverage. For those who want to stick with Original Medicare, Medigap can help with deductibles and copayments.
Medicaid doesn’t have supplements that allow recipients to receive additional services.
Finally, a person qualifies for Medicare based on their age. In some cases, persons with disabilities may be eligible as well. For Medicaid, qualifications vary significantly. In states that implemented Medicaid expansion, more residents qualify, and coverage is broader. Other states will only provide coverage for those with lower incomes who also have children or meet other specific criteria.
The uneven coverage provided by Medicaid makes accessing medical care even more challenging for lower-income Americans. Because Medicare is provided for older Americans, there are fewer stigmas associated with it — although there are still some.
Why is There a Stigma Around Medicaid?
In most cultures, there are mixed feelings about the poor. Those who are “deserving” are approached with sympathy and perhaps charitable aid. Those who are “undeserving” are seen as lazy and unwilling to work and contribute to the common good.
There is also a connection between the poor and immigrants because those new to a country take time to get on their feet. Because many people historically (and currently) fear those who are different, the foreign poor become vilified.
Medicaid was established in 1965, so it’s relatively new in American history. It was only available to lower-income people, so the use of Medicaid was immediately connected to the negative feelings people have about the poor.
In addition, funding for Medicaid comes from payroll taxes. Many who work feel that they unfairly have to pay for those who don’t — completely overlooking the fact that many Medicaid recipients work as well but don’t receive health benefits.
Working With Underserved Populations
Medical providers who work with Medicaid patients have to take extra steps to avoid feeding into the shame and stigma of public health coverage. Practitioners should examine their own prejudices and make sure that these don’t figure into care.
Some medical professionals are being sent specifically into underserved communities to provide care. These areas have a shortage of doctors, hospitals, and services. It’s crucial to understand important facts about these populations, including the causes of “medical deserts.”
Cultural barriers, including language issues, can be a problem, and pervasive poverty can mean a lack of medical clinics and doctors willing to serve the population. Many medical students are less interested in primary care and focus on becoming specialists instead, which means fewer general practitioners nationwide. This reduces the availability of care in more impoverished communities.
As a result, the poor struggle with health conditions that are generally treated in other populations. There could be more heart disease, diabetes, and other preventable illnesses.
Everyone Benefits From Less Stigmatization
There are various reasons for poverty, and much of it is systemic to the way our society and cities operate. There’s no reason for there to be so much stigma attached to Medicaid and public health insurance.
Those who are poor experience discrimination because of their insurance status, even from professionals. Doctors sometimes don’t offer the same tests and care to those using Medicaid due to their own biases. If there were less negativity surrounding public health insurance, Medicaid recipients would receive more frequent and better care.
Even those who don’t like the cost of Medicaid benefit from less stigma about using it. If someone is concerned about paying more taxes to support those in need, they should favor recipients receiving regular preventative care. This helps avoid significant health issues that cost much more to treat.
No one benefits from stigma. It causes a significant portion of the population to avoid care until things are serious, which lowers their quality of life and significantly increases the cost to the Medicaid program.
Blaming people for being poor doesn’t help anyone. With less stigma, we can improve health and life outcomes and help people get back on their feet.