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Lewis W. Diuguid: Dose of shame included in health care for poor

  • Kansas City Star
  • Published Thursday, Nov. 28, 2013, at 12 a.m.

A stigma of shame stalks government health care for the poor and could affect the education children receive in school.

That was the outcome of a study presented this month at an international convention of the National Association for Multicultural Education. Researchers with Tennessee Tech University in Cookeville, Tenn., examined TennCare, their state’s version of Medicaid. The program has been in place since 1994 and serves more than a million low-income residents.

But recipients said they feel saddled with shame, disgrace and blame because they must depend on TennCare. It comes from harsh questions, severe limitations and transportation challenges getting to physicians.

The system “can cause emotional hardships and cause people to avoid health care altogether,” said Amber Spears, instructor of curriculum with the College of Education at the university. That only increases health care disparities.

Spears and other educators said they took on the topic, gathering data, conducting interviews and collecting documents because they saw health care as a big concern for low-income families and children. Poor health hurts kids’ ability to do well in school.

They can’t concentrate in the classroom if they are concerned about the health of a family member. And children who miss school because of their own health problems also fall behind academically.

Researchers said some intrusive TennCare questions included asking women to reveal the number of sex partners they have, disclose how much money they have in the bank and whether their children have savings.

That discourages families from saving money for such things as a car, severely limiting their ability to get better jobs and even to get to their doctors’ appointments, said Alice K. Camuti, director of the Office of Career Services at the university. People with no bank accounts have a more difficult time saving to pull themselves out of poverty.

TennCare clients are made to feel hurt, embarrassed, stupid, lazy, criminalized, angry, humbled and ashamed, said Julie C. Baker, assistant dean of the College of Education at the university. “One person described it as bondage with an underlying feeling of shame,” Baker said.

Welfare and Medicaid recipients in Kansas and Missouri no doubt face the same stigma. Because neither state would expand Medicaid, more low-income people are likely to suffer poor health.

The researchers described how people receiving TennCare also felt threatened with being dropped from the system if they violated any of the rules. That left them feeling helpless.

“You feel like you’re trash,” Baker said. People have to take what they’re given, knowing they are being treated badly.

To close the achievement gap, government has to do what it can to tackle poverty, and fixing a health care system that alienates people must be part of that, said Janet Isbell, an assistant professor in the College of Education. The researchers said they planned to continue to collect data for analysis and talk with state lawmakers about how to make TennCare better for users.

Lisa Zagumny, associate dean and director of doctoral studies at the College of Education, said she hoped the Affordable Care Act, President Obama’s signature legislation, would be the beginning of “a cultural shift to help all users and erase the stigma for low-income families and individuals.”

Revelations from the study should help make health care better for all. Isbell said that ultimately, people regardless of income, government or private market health insurance should receive the same treatment.

The isolation and poverty-driven stigma must end – along with the Obamacare trash talk – ensuring good health for all Americans.

Lewis W. Diuguid is a member of the Kansas City Star’s editorial board.

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