Connecting National Debates on Access to Health Care and the Economic Crisis: A Feminist Perspective

By Stephanie Rytilahti

As the manager of a Wisconsin-based credit union, I witnessed the creaks and groans of the lending industry years before the entire system shuddered and collapsed under the collective weight of bad loans, predatory lending, and an extremely lax regulatory system.  Clients regularly entered my office seeking advice on how to extricate themselves from loan payments that had ballooned overnight into unmanageable sums; how to escape the disastrous cycle of mounting credit card debt; and, simply, how to get a loan at fair terms when low credit-ratings made it impossible to purchase a vehicle or a home.  Many of these clients also lacked health insurance.  

As the extent of the sub-prime mortgage crisis unfolded before an angry and despondent global public, advocates for health care reform were simultaneously exposing the ill effects of a prohibitively expensive and increasingly exclusive American health care system.  Yet, these two crises were rarely connected. Even today, economic calamity and health care abuses are treated as two different phenomena — although both elicit concern and are targeted as structures in need of major reform.

Individuals suffer profoundly when the failings of the two systems intersect, yet the public rarely focuses on the interconnections between the health care and financial industries. This oversight obscures two critically important factors. First, it masks the multiple inequalities that are built into both the health care and financial industries. Second, it limits our ability to understand how these inequalities play out as an individual leaves a hospital with mounting medical bills and later enters a financial institution to find that both systems work together to limit access to societal resources and create situations of vulnerability.  The financial problems associated with lack of access to health care are exacerbated by a lending system which treats unpaid medical debt as a delinquency on credit reports which can depress credit scores for up to eight years.  Hence, fair lending terms become increasingly elusive for individuals who struggle to cover the costs of medical care.       

In 2008, as a graduate student at the University of Wisconsin-Madison and a teaching assistant in a prominent women’s health course, I published an article on these intersections.  My goal was to create an article for college students that exposed how unpaid medical bills (based on inadequate or non-existent health insurance coverage) translated into financial vulnerability.  My message was that inequalities that are built into one societal structure (like health care) are multiplied and replicated when they come into contact with other institutions (like the financial world).  The same individuals who are disproportionately denied access to health insurance based on race, class, citizenship status, and/or sexual orientation (i.e., lack of access to privileges through one’s partner) are also disproportionately denied access to loans as unpaid medical bills depress their credit scores and make fair lending terms elusive. Yet, the biases and prejudices built into both credit rating systems and access to health care are easily masked. Real societal inequalities are easily ignored in favor of conversations about individual irresponsibility and culpability. Low credit scores and unpaid debts are pinpointed as the cause of an uneven lending terrain. In the arena of health care reform, injurious insurance practices play a similar role.  Issues of poverty and related inequalities are masked by confusing industry jargon which denies claims on the basis of (what does this mean??  On the basis of staggering premiums is not a basis for denying claims) staggering premiums, pre-existing health conditions, and other factors.  It can be challenging to search for and understand the deeper societal issues at play: a complex system of irresponsible lending, unequal distribution of wealth, and a financially punitive health care system.

In my article, I used the example of a fictitious woman, Helena, to walk students through the various intersections of the health care and financial industries as she attempts to get a loan after acquiring mounting and unpaid medical debts.  Helena is an amalgamation of the many clients with whom I worked during my seven years of experience in multiple aspects of the financial industry: single mothers, undocumented workers, same sex partners, and racial and ethnic minorities. Helena’s experience provides tangible examples of exactly how inequalities intersect across societal institutions and how easy it can be to overlook these connections and their impact.  I was surprised by how many of my students were intimately familiar with these issues through their personal experience.  Many had unpaid medical bills or had watched their family members struggle with unfair loan terms as a result of unpaid medical debt and the negative impact this had on credit their credit scores.  

In the wake of the recent Massachusetts U.S. Senate elections, much of the legislative reform surrounding health care and lending abuses has been potentially weakened. As we continue the historic effort to revamp our nation’s health care industry and implement new regulations on lending and health insurance practices, it is critical to keep the overlap between these two systems in mind.  My students, their families, and the clients I assisted in the financial sector are well aware of how these connections restrict access to good health care, fair loans, and mental and physical well-being. It is important that our lawmakers also understand these intersections.   
    
Stephanie Rytilahti is a graduate student in the department of gender and women’s studies at the University of Wisconsin-Madison.  Her research interests include social justice activism, women’s health, and second and third wave feminism.  This article reflects her experiences as a credit union manager in Madison, WI from 2004-2008.