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Unequal CoverageThe Experience of Health Care Reform in the United States$
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Jessica M. Mulligan and Heide Castañeda

Print publication date: 2017

Print ISBN-13: 9781479897001

Published to NYU Press Scholarship Online: September 2018

DOI: 10.18574/nyu/9781479897001.001.0001

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PRINTED FROM NYU Press SCHOLARSHIP ONLINE (www.nyu.universitypressscholarship.com). (c) Copyright University of NYU Press Press, 2021. All Rights Reserved. An individual user may print out a PDF of a single chapter of a monograph in NYSO for personal use.date: 18 September 2021

The Responsibility to Maintain Health

The Responsibility to Maintain Health

Pharmaceutical Regulation of Chronic Disease among the Urban Poor

(p.207) 8 The Responsibility to Maintain Health
Unequal Coverage

Susan J. Shaw

NYU Press

Susan J. Shaw’s chapter examines the management and regulation of low-income residents' access to and coverage for medications in Massachusetts. This chapter shows how Medicaid patients experience accountability in health care as they struggle to pay out-of-pocket costs for their medications and endure frequent eligibility re-certifications for insurance coverage. Their physicians are subject to insurers’ cost savings measures that include changing lists of covered medications. Shifts in medication benefits intersect with complex pharmaceutical beliefs that shape low-income patients’ adherence to biomedical care for chronic disease. Utilizing insights about the importance of “audit culture” to regimes of accountability, she argues that the Massachusetts experience of health care reform serves as a cautionary tale of the diverse costs of health care reform in neoliberal moral economies of care.

Keywords:   accountability, Massachusetts, health care reform, Medicaid, adherence, neoliberal, moral economies of care, audit culture, pharmaceutical beliefs, cost savings

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