Choice: A Privilege for Those with Health Insurance

By Heidi Connealy
Ph.D. candidate in Medical Anthropology at MSU

For the past 14 months, I have conducted dissertation research in the form of participant observation and in-depth interviews at a Lansing nonprofit that provides a variety of “safety net” services to help low income individuals meet their health, food, and wellness needs. The primary focus of my research is to observe the role of the non-profit in public health promotion and wellness management in the wake of privatization and decreased funding of public social services. Many of the people who rely on this non-profit have difficulties getting everything they need to stay healthy. Most of these individuals are confident, savvy, and capable of making decisions about their health but lack the means with which to gain necessary health care, medicine, and food.

During my research, I have conducted health outreach, assisted with a number of health programs, acted as an advocate for people in need of public services like food stamps and Medicaid, and helped people enroll in the Ingham Health Plan (IHP). Managed by the Ingham County Health Department, IHP provides primary care and limited drug coverage to low income individuals without health insurance. The IHP is a laudable endeavor that has improved access to care for its participants. However, many individuals with serious acute and chronic conditions find the scope of IHP limited. Although a majority of the non-profit participants with serious health problems meet the financial requirements for Medicaid, very few are able to enroll; new enrollment in Medicaid is largely limited to pregnant women, disabled adults, children, and new refugees. Many people who would be eligible for Medicaid if they became officially disabled continue to work because they cannot afford to live on the amount of money allotted to them through Social Security.

The lived realities of the individuals served by this nonprofit suggest that patient choice and autonomy are luxuries reserved for Americans enrolled in private or public insurance plans. My observations lead me to conclude that patient choice and autonomy have little relevance for the 45 million Americans without both health insurance and regular access to care.