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# Medicaid, Poverty, and the Illusion of Care: Insights Drawn from Viola Davis’s Memoir

Experiencing Viola Davis’s memoir, *Finding Me*, is profoundly moving. Davis’s poignant portrayal of the compounded difficulties faced by those who are both Black and impoverished—the “one-two punch” that influences every facet of existence—challenges our understanding of systemic inequality in America. It’s not merely the absence of resources that confines individuals. It’s a system intricately designed to keep them ensnared, regardless of their efforts to escape.

This insight struck a chord with me, especially when recalling an event from my tenure in a pediatric emergency room a decade ago—an incident that profoundly changed my perception of Medicaid and its shortcomings in serving the families it promises to assist.

## The ER Encounter That Altered My Perspective

At the beginning of my journey back into pediatric emergency medicine, equipped with the new electronic health record system, I could finally track a patient’s complete medical history. During one of those shifts, I encountered a two-year-old Black boy. He had no chronic conditions, no significant health issues, and came in with just a mild fever and cold symptoms.

What captivated my attention was this: it was his 26th visit to the ER.

As I stepped into the room, believing I could provide a valuable solution, I proposed helping the mother locate a pediatrician. Her response was a stark wake-up call:

> “Doc, you don’t understand. I work Monday through Friday, 9 to 5. If I miss work, I lose my job. Our assigned clinic is open Monday through Friday, 9 to 5.”

She was not in the ER by choice; she had no viable alternatives given to her by the system.

That night, I came to realize that Medicaid, despite its noble intentions, was not aiding this child—it was ensnaring him.

## Coverage ≠ Care

Viola Davis articulated it aptly: poverty isn’t merely a shortage of money—it’s a thick, enduring haze that obscures every choice. Medicaid is intended to combat this haze. Instead, it frequently exacerbates it, presenting an illusion of access without genuinely providing care.

Despite enormous expenditures and broader enrollment, fundamental inequalities persist:

– Black infant mortality rates are still double those of white infants.
– Black children are hospitalized more frequently for preventable conditions, like asthma.
– Black Medicaid recipients face longer wait times, fewer referrals, and worse health outcomes overall.

In essence, an increase in Medicaid coverage has not translated into substantial improvements for Black families. It has fabricated a facade of success while reinforcing pre-existing disparities.

## Tracing the Funding: Who Truly Gains?

Medicaid has morphed into an $800 billion annual program—but its expenditure patterns highlight its shortcomings. A significant portion of the funds benefits:

– Insurance firms and managed care entities,
– Hospital systems,
– Healthcare conglomerates.

Meanwhile, Black children on Medicaid—who are the intended beneficiaries—continue to experience disproportionately negative outcomes. We spend more on hospital stays, emergency admissions, and administrative tasks, but not on ensuring healthier children or more accessible healthcare.

It’s about quantity, not quality.

## Medicaid in the South: An Example of Broken Promises

Southern states exemplify Medicaid’s deficiencies:

– Mississippi, which has not expanded Medicaid, still has 55% of its children relying on public insurance (Medicaid or CHIP).
– South Carolina, where Viola Davis spent her childhood, endures among the highest Black infant mortality rates in the nation.
– Numerous rural hospital closures—many in Black neighborhoods—have deprived entire areas of local healthcare options.

High enrollment figures do not guarantee improved outcomes or better access. In many regions of the South, Medicaid has been reduced to little more than a paper promise—not a solution for enhanced health.

## Rethinking Medicaid: From Illusion to Real Change

The central issue isn’t merely a lack of funding; it’s a misalignment of priorities.

Instead of continuing to funnel billions into hospitalizations and emergency services, Medicaid should:

– **Invest in results, not just interventions.** Incentivize providers who maintain children’s health and minimize avoidable crises.
– **Broaden flexible care options.** Promote after-hours clinics, urgent care facilities, and telehealth access for working families.
– **Hold insurers accountable.** Healthcare plans that do not improve children’s health outcomes should not continue to receive public funding.
– **Support working families.** Reevaluate policies (like mandatory doctor’s notes for minor ailments) that inadvertently burden children and their caregivers.

Slashing Medicaid isn’t the solution—intelligent and focused investment is.

## Concluding Thought: Medicaid Shouldn’t Be Another Blow

As Viola Davis emphasizes, poverty often resembles a relentless assault. Medicaid was intended to be a source of support—an avenue to help vulnerable families stand a bit taller and endure a bit longer. But for far too many Black families, it has become yet another source of hardship.