I didn’t have health insurance for the longest time and I have always been sort of illiterate in terms of navigating the bureaucracy of the system combined with the ever-changing legal policy around Who Can Get Care, When, and How. (This is the kind of thing that only career experts in the unique American system of health insurance understand, I am convinced.) I was lucky to be on my parents’ plan in college, but I don’t think I took advantage of it even one time. I had no medical conditions or tragic accidents and, stupidly, I never got a physical or yearly checkup. The one time I did see a physician was when my boyfriend (my eventual ex-husband), shocked and appalled to learn that I had never gotten a pap smear or a pelvic exam after many years of being sexually active, convinced me to schedule an appointment for these then-embarrassing but today-mundane procedures at Planned Parenthood, out-of-pocket. I was still on my parents’ plan, but the stigma around women’s health and sexual activity was heavy on me, and I was afraid that if I used their insurance, they would find out that I had this scandalous and shameful exam. What could have happened? Would they suspect I had sex? Would they have disowned me? Cut me off? Simply yelled at me? Would my mom have cried? No, never, but we may have had a tense and uncomfortable conversation, and I think I would have rather died than sit awkwardly before my parents as an adult for the “we’re-not-mad-we’re-just-disappointed” talk that I zoned out and dissociated through so many times in jr. high and high school.
Very long story very short, I ended up getting an abnormal result which led to more appointments and eventually having cancerous tissue surgically removed from my cervix. But if I hadn’t gotten that first exam—which I delayed because of shame and stigma around my own health and body—I could have had a seriously bad outcome. I could be infertile and not have Alice or any more children. I could be dead. I could have just continued to ignore my health and ended up with an unintended pregnancy or some other thing. The point is, as we all of course know, preventive healthcare saves lives and unnecessary cultural stigma stands as an obstacle to getting that care.
In addition to about a hundred million other institutional obstacles produced intentionally by insurers, providers, and government in the United States.
When I got divorced in 2013, I lost my health insurance.
I was uninsured and never went to the doctor until 2017 when I qualified for Medicaid.
In 2018, I got a $70/month raise, which bumped me off of Medicaid (in what’s commonly called the “cliff effect”) and into the health insurance gap where millions of other Americans were also stuck. The value in dollars of the raise I got was nothing compared to the loss of the healthcare and other benefits I had been eligible for at a lower wage. Although I had every incentive to reject the pay raise and go back down to a lower wage, I also had this Proud Midwestern Hardworking Bootstraps thing, I thought I was going in the right direction, I didn’t want to go back, and I wanted to keep seeing my earnings rise.
But they didn’t rise. I worked hard, I built a business that was successful, I supported nine employees, but I did not ever break through to the wage level I needed to get out of the Medicaid gap.
In 2018 I won an election for the State Legislature. My earnings tanked—I could no longer run my business the way I was, I did not have savings, and I relied on the $12,000/year salary plus the small per diem Nebraska State Senators receive. No benefits. No insurance. But still earning too much to qualify for Medicaid, but not enough to afford a plan on the marketplace. Still in the gap.
In 2021, I finally became eligible for Medicaid when Nebraska expanded Medicaid, passed by the voters through a ballot initiative in 2018. After a two year delay, the state implemented a shitty tiered benefits system with work requirements and a confusing labyrinth of networks and paperwork, but here we are. I can go to the doctor now. I think. ?? Seems like I should be able to?? The state mailed me a card?? But it still seems like a trap because I have literally never had a smooth or easy experience receiving healthcare in this country?
This year I had a few medical issues—the first major ones of my life where I thought, “Oh no, I need to see a doctor.” There is a serious history of skin cancer in my family, and I had two changing-growing-bleeding-weird spots on my body that I knew, that at nearly 35, I should not ignore. I also had a mass, a lump, a gross thing, growing inside my cheek that grew and grew for a year. It hurt, it grew, it was affecting my speech and my ability to eat, and it was just so gross. It started to become visible when my mouth was closed. Just like….so gross.
After four appointments and referrals and followups and form-filling-out over the course of two months, I finally got it removed on Thursday. My cheek is full of stitches. It’s MORE disgusting. Oh my god. It pulls the stitches painfully to smile or to open my mouth or eat. I’ve been drinking these inventive tofu-based smoothies, blended with fruit or cocoa and peanut butter. The surgery was painful. The healing is painful. Obviously it’s FAR AND AWAY not the most serious medical thing for a person to go through. But to me, compared to what I have experienced, it feels like a big deal.
And I haven’t gotten any bills. I just showed them my card.
This surely can’t be all there is to it.
The other thing like this, of course, was getting the COVID-19 vaccine. I made an appointment online. I went to the pharmacy. I offered the pharmacist my Medicaid insurance card, and she waved it off and said “Oh, I don’t need that, honey.” Over three weeks, I received two injections of a live-saving vaccine, for free, to finally bring an end to the most tragic and endless year of our collective lifetimes. For free. I was in and out. It all ended in a Hy-Vee.
It is amazing, gut-wrenching, mind-blowing, to think that in the United States, it could be this way all the time. Younger Megan could have gotten a pap smear without shame and without cost, potentially avoiding a scary diagnosis and expensive surgical procedure. I could have gotten physicals. I could have had spots looked at as soon as they started to turn weird. I could have gotten on a good antidepressant much earlier in life, without fear of the price of appointments or medication. We could all have this peace of mind. We could all know that we can just get the care we need when we need it, without having to prove that we deserve it or debasing ourselves at horrible jobs to earn the right to receive it.
Anyway this is not a new idea whatsoever.
But it’s on my mind because I have all these horrible disgusting stitches in my cheek that I didn’t have to pay for, I will feel better soon, and I hate this entire system that has been chosen for us by people who will never ever worry about whether they can afford to go to the doctor.
I mentioned in the last newsletter that I was starting a new retail project called 5/9, selling independent design and collectible vintage. Artist and metalworker Lindsay Lewis is the newest designer I’m carrying. I love the asymmetrical shapes and organic aesthetic of her work, and I hope you will too. The hand-cast brass and Czech glass beads of the Avery Earrings are my favorite. It’s an aesthetic I think is incredibly cool.
What else?
I downloaded Audm, an app where you can listen to articles from the New Yorker, The New York Times, Vanity Fair, The New Republic, all these different publications read aloud. I put on a ten-minute article to fall asleep to, and I listen to hour-long articles during my commute to Lincoln. I got the year subscription. It’s my absolute favorite app now. I like it better than podcasts. It lets me consume the articles I would be reading if I wasn’t driving or sleeping. So now when people say “Oh, did you read about XYZ,” I can usually say yes.
I am fully vaccinated
I am fully agoraphobic
Yet I am planning to travel a LOT this year. Some of that time away will be possible because I have learned so well how to work remotely. This is something from quarantine that I will be taking into the future — I do not need my butt to be in a chair in Omaha to be working. Maybe that chair will be in Paris or Berlin or Hawaii or Morocco or in a tent at a National Park or at my grandparents’ house in Boca Raton…
On another contrary note, I am looking for a space in Omaha for retail, studio space, and office space. It turns out I really like having a separate workspace. I really cannot meet my potential without it. This will be one of the many quests I embark on this year.
More to come. If you know someone who would like this in their inbox, forward it to them and tell your friends to subscribe. Follow me on Instagram and Twitter, too. If you have a question about navigating the system, getting a benefit, or are generally pissed at the government, contact my fed account at mhunt@leg.ne.gov. Help me pay my rent and validate the work that fulfills me by shopping at 5/9. Get vaccinated, and stay safe!
Meg