Post-Graduate Healthcare Advice OR Structural Violence and the Kafkaesque Machinations of the State

I’ve been planning this blog post for a long time. You see, I recently graduated from my Ph.D. program, meaning my university provided healthcare came to an end and I faced “the market” through Covered California.

It’s hard to figure where to start in a story like this, so let me start with a brief preface about privilege, visibility, and healthcare.

I come from a relatively comfortable working class family. As a child, I had some great healthcare. My dad was a union man and his union had some very good health insurance (I believe he was and is Teamsters local 710). My mother, being a nurse, could always bug other healthcare professionals for recommendations and help. I stayed on my father’s insurance as long as I could, but 23 came and went and I opted to take my grad program’s healthcare plan at UC Santa Barbara. Although the care can sometimes be inconsistent, the convenience and ease of student health insurance is unparalleled. I was also healthy enough to avoid any major healthcare costs, save one surgery.

And thus, I found myself 29 years old, graduating from a Ph.D. program, and actively seeking my own healthcare for the first time in my life. I applied for healthcare via Covered California and automatically applied for Medi-Cal at the same time. This was in late-March. I was finally able to purchase healthcare through the Covered CA marketplace in mid-May, just before my 60 day tax penalty window closed. If I had run into but one more snafu, had linguistic trouble, less access to the internet, or less reliable mail service, I would be paying through the nose for this come next April. (So, again, my relative privilege is visible in how I resolved this problem).

The online application process itself is convoluted and requires multiple steps, including the submission of personal documents to validate your residence and income. Furthermore, because the rates that one pays for insurance vary based on those two factors, one can not simply buy insurance when needed. (Sidenote: if anyone in need of healthcare is reading this, the best way to get help is by far to contact the Covered California Service Center via phone, when I FINALLY got my situation sorted out, it was through the help of someone there. Here is a link to their contact info. Be prepared to spend a couple hours on the phone, though… literally.)

So, from late-March to mid-May, I attempted to get healthcare. During that time, I monitored my application status on the Covered California website, and noticed that I hadn’t received clear word about whether I qualified for Medi-Cal or not (supposedly it was not-so-directly stated in the first correspondence I got from Covered CA…). So, seeing the slump and no word on Medi-Cal, I applied separately to that. Which indirectly held up my Covered CA status, because you cannot be “double covered.” This sent me down to a local branch of the Department of Public Social Services, often referred to with some resentment as ‘the Welfare Office’ among some groups. What I saw there was a revelation.

My day at DPSS began around 10am, as I queued up with the rest of folks without appointments and waited to get inside. I live at the edge of Koreatown and Westlake in LA. It was a short walk to a local DPSS office, there were actually two within a mile of me. I was going to submit my residential, identification, and income documents in person, and in hopes of speaking to someone about the timeline and whether I was even actually eligible for Medi-Cal at all. The two-and-a-half hours I waited in line to speak with someone exposed me to a more diverse crowd than I’ve seen anywhere else in LA. I heard four different languages being spoken, saw folks of all races, and saw people of all ages — including children trying to entertain themselves in a sea of bored folks waiting in line. When my time was up and I got to the front of the line, I asked the clerk about my eligibility and about my application through Covered CA. I learned that he wasn’t sure if I was eligible, he’d have to pass the info on to the actual caseworker upstairs who had access to my residential/income/and district info and could determine that. He also explained that although one applies to Medi-Cal directly through Covered California, it can take up to three months for your application to be processed that way (read: one month longer than the system allows for before locking your Coverd CA app and giving you the individual mandate tax penalty). He lauded me for taking the initiative in applying and for coming in person, saying I sped things up.

Fast forward a couple weeks. I still have no word from Medi-Cal and hence no word from Covered California. Finally, I break down and call the help line. I am informed by the Covered CA rep that I was definitely not eligible for Medi-Cal, because of the relative poverty of my residential district. About 2.5 hours later, I’ve selected a healthcare plan and spoken to a sales rep from Kaiser Permanente about it. Then, I had to immediately call my DPSS caseworker and cancel my Medi-Cal claim, or risk having my health insurance pulled.

A few days later I paid for my insurance, beat the tax penalty, and everything was peachy keen… er … well kind of.*

The reason I want to tell this story is not to complain, if anything, the experience made me even more conscious of how privileged I was to have avoided waiting in line at DPSS to this point in my life. There are two key points to this story: 1) as a lesson for seniors graduating college or people leaving advanced degree programs, 2) as a lesson about structural violence for people privileged enough not to have had to seek healthcare through the marketplace or to have applied for medi-cal or social assistance programs.

This whole process has been like being trapped in a Kafka novel peopled with characters out of the mind of Samuel Beckett. It’s given me firsthand experience of the violence of deferral and displacement enacted on the poor in this country (and, to be fair, in others). I’m reminded of the work of anthropologist and humanitarian, Paul Farmer, who has written extensively about the suffering of and violence toward the global poor. Although, it hits all the harder because it is right outside my door. And probably right outside of yours.

At the same time that I was getting my taste of this structural violence, I noticed another enactment of it just down the street.**

For several months, a group of homeless folks in tents had begun camping in a small community between Occidental and La Fayette Park Pl on 6 ST. I walked and drove past this small community countless times and found them to be polite, kind, cordial, and quite neat. They had a community trash-bin and signs scolding those who don’t pick up after themselves. I watched this community grow from a raggedy tent or two into a small 3-5 tent neighborhood. I watched kids at the nearby school say hi and chat with them. I noticed how the street actually stayed cleaner with them on it. Just a few days after my visit to DPSS, I saw that they were basically being evicted by the city of Los Angeles. Signs for an imminent tree trimming were posted  all along their one-block of real estate… and nowhere visible nearby. These signs demanded that the space be cleared. After the tents and their occupants disappeared, orange mesh temporary fencing was put up around the area. The tree trimming came and went. The mesh remains. The people have not returned. The street is now much dirtier. It is also less social. A piece of the community was displaced.

Although this displacement may seem disconnected from the deferral enacted by the healthcare marketplace and the social service system, it actually speaks to a broader structural violence directed largely at the poor and needy. It is a violence of deferral and displacement. A violence that millions of Americans suffer everday, and to which millions more are blind. I’d also just like to mention that, given the strong connections between race and poverty, it is hard not to see this structural violence as tied to broader social issues with which the country is currently grappling.

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*The healthcare saga continues and I am still struggling with ridiculous bureaucratic red tape. I finally got this whole healthcare thing sorted out in May, mind you, but I was being charged for healthcare since March. Another 2 or 3 hour phone session later and I had things resolved… or so I thought. I recently received a letter from DPSS about having a new caseworker. And I received a healthcare card from a company I never bought healthcare from, so, a full three months later I am still dealing with this.

**Again, it is but a taste, I still live far more comfortably and with far more privilege and power than many of the folks I stood in line with, something that bears repeating for perspective.

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