Pregnant, on Medicaid, and Being Watched

IF YOU’RE RELYING on the public health care system, you’re living your life under surveillance, says Khiara Bridges, a law professor and anthropology researcher at the Boston University School of Law.

All sorts of incredibly invasive details about your life, including sexual experience, eating habits, and job history, are stored in databases that are accessible not only to your caregivers, but potentially to law enforcement, too, she says.

Bridges will be discussing her research on the routine and invasive monitoring of women who require certain public health care assistance on Friday at a Georgetown Law School conference titled “The Color of Surveillance: Government Monitoring of the Black Community.”

Her first book, Reproducing Race, featured four women at a New York City public hospital whom she followed from May 2006 to September 2007. These women were enrolled in the Prenatal Care Assistance Program, which serves uninsured and underinsured women, including undocumented immigrant women.

The women start by going through what she calls “information canvassing” in order to enroll — answering questions on topics “from sexual abuse, to intimate partner violence, to how often they ate, what they ate, how they make their money, how their partner makes their money.”

They are then required by law to speak with nurses, health educators, HIV counselors, social workers, financial officers, and others.

“Their lives are just so open to observation and regulation,” Bridges says in a phone interview.

These “case management services” are officially there to provide help in “gaining access to needed medical, social, educational, and other services.”

But Bridges argues that the questions sometimes stray into the unnecessary, invasive, and non-medical territory. She calls it “a gross and substantial intrusion by the government into poor, pregnant women’s private lives.”

Bridges says she is publishing a new book next spring called The Poverty of Privacy Rights — zooming in on just how little privacy the underprivileged have under systems like Medicaid. She’s explored the topic in several law review articles, including one at Harvard titled “Privacy Rights and Public Families.”

Those who can afford private health care get to pick what they say to whom, Bridges says. “They don’t have to talk about the past if they don’t want,” she explains. They can protect their privacy through their wealth.

Bridges is particularly concerned about exceptions in the law that allow for incredibly personal information to be shared with law enforcement. As she writes in a section of her forthcoming book:

Crucially, the Privacy Act contains exceptions that allow for the nonconsensual disclosure of collected information. Intriguingly, one of those exceptions “allows disclosure to other jurisdictions for law enforcement.” The result of this exception is that when a population is imagined to be inclined toward criminality, then that population exists in a state of exception under the Privacy Act: Its information can be disclosed as long as it is for law enforcement purposes. …

… Undeniably, welfare beneficiaries are one of those populations that are thought to be comprised of criminal elements. The irony should be apparent: The act that provides protection from the disclosure of information, and thereby saves the constitutionality of information-collecting regimes, itself provides for disclosure.

Other researchers and groups, such as the Stop LAPD Spying Coalition, are concerned about the surveillance of people who enroll in Electronic Benefit Transfer programs to buy groceries, or take advantage of other public benefits.

The monitoring of people who need public assistance has long been an issue with feminist thinkers and other legal scholars.

Maria Cristina Rangel, a feminist activist and mother who relied on the public benefits system, wrote in a 2001 book:

The whole system is based on the assumption that you are trying to screw [welfare officials] over. There are constant check-ins and impossibly long lists of “verifications” to submit to the state in order to back your story; inquisitions involving a battery of questions asked by countless supervisors behind closed doors when it appears that your story does not add up … [and] if you don’t comply … your benefits can be cut.

Bridges remains focused on everyday public health care monitoring. And, she says, “The least scrutinized program is Medicaid.”