title: "They Treat you a Different Way:" Public Insurance, Stigma, and the Challenge to Quality Health Care.
abstract: 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.
authors.affiliation: Department of Anthropology, Michigan State University, 355 Baker Hall, 655 Auditorium Drive, East Lansing, MI, 48824, USA.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Martinez-Hume
authors.affiliation: Harvard T.H. Chan School of Public Health, Harvard University, 677 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Baker
authors.affiliation: Department of Anthropology, Michigan State University, 355 Baker Hall, 655 Auditorium Drive, East Lansing, MI, 48824, USA.
authors.forename: Hannah S
authors.initials: HS
authors.lastname: Bell
authors.affiliation: Department of Sociology and Anthropology, University of Texas at Arlington, 430 University Hall, 601 S. Nedderman Drive, Arlington, TX, 76019, USA.
authors.forename: Isabel
authors.initials: I
authors.lastname: Montemayor
authors.affiliation: Center for Health Equity Research, Northern Arizona University, 1100 S. Beaver St., Flagstaff, AZ, 86011, USA.
authors.forename: Kristan
authors.initials: K
authors.lastname: Elwell
authors.affiliation: Department of Anthropology, Michigan State University, 355 Baker Hall, 655 Auditorium Drive, East Lansing, MI, 48824, USA. huntli@msu.edu.
authors.forename: Linda M
authors.identifier: http://orcid.org/0000-0002-1214-8569
authors.initials: LM
authors.lastname: Hunt
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008297:Male; D008483:Medical Assistance / Q000592:standards*; D008875:Middle Aged; D036301:Qualitative Research; D011787:Quality of Health Care / Q000592:standards*; D057545:Social Stigma; D055815:Young Adult
keywords: Healthcare; Insurance; Intersectionality; Medicaid; Poverty; Stigma