Friday, October 5, 2012

Medicaid changes accept childless adults' diversity

Brilliant link-picker Alice Wong (@SFdirewolf on Twitter) has been kindly sending me items lately.

Last week she sent over this Kaiser Family Foundation article on a happy likelihood in the Affordable Care Act (ACA, a.k.a. Obamacare). It introduces this report saying that, in states that opt into the Medicaid expansion, Medicaid coverage (Medi-Cal in California) will be available to most homeless childless adults who don't qualify for federal disability benefits.

This is a huge improvement.

I mean, the Kaiser people are right to note that enrollment will be an awful pain in the neck, and that some very low-income people have a serious gut aversion to offices and paperwork, and so eligible people and the programs trying to serve them will have to work pretty hard to get past these barriers.

But it's so nice at last to be able to view Medicaid eligibility in case of serious poverty as a matter of paperwork, not flat-out ineligibility.

It's a change that reflects shifting attitudes about the ways people can or should find to get by.

It used to be assumed, I think, that low-income unattached adults were normatively sturdy, stoical and male -- basically, soldiers. Now the United States has changed just a bit. Women alone are not so reflexively presumed to need attachment. Men are not presumed to be invulnerable.

I don't mean to say Medicaid inclusion was based on any such thoughts in particular, but that it's possible now partly because independent women and vulnerable men are now that bit more understood to be normal.

I'm old enough to have noticed a change in this area during my own career.

My first work as a law student and lawyer was with childless single adults, especially California's county General Assistance programs.

As of the early 1990s, General Assistance programs tended to have rules and procedures meant for male laborers, possibly male military veterans, presumptively in rude health. In rural Butte County in 1993 one of the few available special allowances under local General Assistance rules was for "work boots". Not for any other kind of shoes. (I wonder, for example, if a cashier or nurse's aide could have asked for help buying support shoes for long days of standing.)

Medical care was an afterthought, a frill, except when it came to people with disabilities that were sufficiently definable to qualify them for federal benefits and hence relieve the county of their support. If you weren't classified as fully unable to work, you needed no care at all. An attitude reminiscent of the British Army medical official who asked Florence Nightingale "with a growl, what a soldier wanted with a tooth-brush."

Now I think it's more understood -- anyway more reported in the news -- that poverty damages health, even the health of men, and maybe also that stoicism isn't a manly duty.

Childless adults, alone and without money, who happened to be female used to be treated as virtual men, hence not well provided for in shelters and expected to get by in offices, workfare programs and other contexts created with men in mind.

Behind that I'm sure was the old assumption that a woman ought to have either a man or children to care for. That a woman without existing obligations to others could and should support herself by taking them on. That a woman without attachments is not only unnatural but a sort of dangerous free radical who will cause disputes over her ownership. (One of the residential hotels in Redding, California was still banning women as tenants for that very reason as of 1993.)

The assumption that unattached adults are male was persistent despite good intentions.

There was the time in the mid-1990s when I suggested to an advocate from a family welfare rights organization that her group could work more closely with my own advocacy office, which served single adults. She declined, saying "Your clients are my clients' abusers." That is, adults without children must be tough men; women who need financial help are ipso facto mothers.

In 1998 I took a drive alone down the Oregon coast. In a midsized town I went into a place to ask about campgrounds. The person at the counter presumed I must have children waiting outside. Later the campground manager, when I pulled up, also assumed there must be kids. Even though I was the only person in the car.

I don't know if that would still be true. It's a long time since I've been to a campground alone.

It's encouraging, anyway, to see not only the Medicaid extension but a change of attitude in news reports about homeless female veterans. It's suddenly understood that there are women who should not be expected to survive by becoming ancillary to children or men.

For example, a while ago @kathrynrharris (via @ReddingHomeless) found this Washington Post report on shelters designed for women veterans, especially one near DC that sounds like a good thing despite the mildly creepy name of "Final Salute".

Apart from helping the veterans, I think it's good because it recognizes childless manless women as a distinct constituency, not an afterthought. Maybe it's understood that women who have faced enemy fire cannot be told to survive by making themselves into helpmeets or unpaid domestic servants.

Maybe we're starting to believe in women who insist on belonging to themselves.

Maybe we're starting to believe that men aren't weak who admit to imperfect humanity.

Maybe the world slowly turns for the better.

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