Insured While Fat

by Shaker MaryAnn

[Trigger warning for fat hatred, body policing, disordered eating, and ableism.]

Attaining decent health care is no easy feat. Most of us know this, whether we have been denied coverage because of "pre-existing conditions," are forced to pay ridiculously high co-pays, or are simply unable to access care at all. I recently experienced a new, unexpected obstacle when it comes to accessing health care: The insurance plan offered by my employer through Blue Care Network of Michigan, requires that I enroll in a "weight management plan" in order to receive premium insurance. I am 5'4" and weigh 244 pounds. Anyone with a BMI over 30 must enroll.

So, this leaves me with a few choices (if you can even call them that): 1. I wear a pedometer and step a certain amount of strides every three months or I enroll in Weight Watchers and attend meetings once a week. 2. Choose the substandard plan, which has high premiums and co-pays and is barely worth the paper it is printed on. 3. I pay a boat-load of money for the "Cadillac plan." It offers relatively good care, but also with high, high co-pays and high, high associated costs. I work as a medical assistant. The last option would require that I give up half of my paycheck every two weeks. So that's out.

What did I opt for—my dignity or decent coverage? I tossed my dignity right out the window and opted to wear the pedometer. I am pretty active, so I easily walk the required amount, but that misses the point. People who are fat and not active—whether by choice or disability—deserve care, for one. And every time I put the pedometer on me, I am reminded that I am a fatty who does not deserve care unless I am always striving to be something that I am not. I am reminded of my past; I think about days spent throwing up everything I ate and counting calories until my head spun. I am reminded that the majority of people in this country think I am disgusting, worthless, and deserve to get sick and die. (This, too, is eliminationism.) Every time I touch that pedometer, that's exactly where my mind takes me. I cannot help but think this was part of the intention.

This particular insurance plan is cheap for my employer. I get it. Times are tough and money is tight. So Blue Cross offers a plan that is cheaper for big companies but punishes certain types of people for certain types of things. I have a dear friend and co-worker is a proud junk-food aficionado, not terribly active, and weighs 110 pounds. This insurance plan works wonders for her. She is all set. Folks with a BMI over 30, those with depression, and/or people who smoke are all required to jump through the hoops in order to access this care. So I jump. (Also: Why are we equating smoking, fat, and depression? So many issues here.)

It took me about three months to find a physician that would accept me as a new patient. I tried to make appointments with doctors who were recommended to me as fat-friendly, but I was unable to see any of them. Why? Because, within the first three months of Blue Care Network enrollment, enrollees must complete a "health assessment" and subsequently have a physician fill out a qualification form. I would have missed this deadline if I had made an appointment with my preferred physician. Most offices I called had a two- or three-month waiting list.

The online assessment took about an hour and asked me all kinds of questions about my lifestyle and ostensibly about my health. Did they want to know that I have terrible allergies? How about my intolerance to gluten and the severe reaction I have when I eat it? Nope. They wanted to know how much I am going to cost them. They asked me about my weight, if I was a suicidal drug user, and about my tobacco intake. They asked about my eating habits and activity level. These companies do not care about health. They tell us, over and over, how they care about wellness and preventive care. They care about money. That's it. End of story.

Luckily, when I went to see the physician, she was sympathetic about the hoop jumping and filled my form out quickly and easily. I then received emails and letters telling me YOUR BMI IS SO HIGH YOU ARE GOING TO DIE TOMORROW (paraphrased) and that I needed to select a pedometer or Weight Watchers. Truly, the thought of weekly attending meetings that would feel self-hating to me made my blood pressure and anxiety go through the roof. So I wear my pedometer everywhere I go.

And everywhere I go, I am reminded that I am viewed as a burden. I am reminded that, until I change, I am not worthy of decent health care. I am reminded that I am hated.

Of course, I know this already. I see it everywhere I go. Most fat folks do.

I see it on the faces of the people I try to push past in the restaurant, but my fat makes it harder to get through. I am reminded when I barely fit into airplane seats. I am reminded at the hospital, when the doctors and nurses give me glances containing equal parts disgust and pity.

Yes, it is just a pedometer. No, it is not a huge ordeal to attain my allotted steps. But every time I tuck that little pedometer into my bra or clip it to my pants, I am reminded of how much anger, pity, and disgust society has for me and folks like me. As if it were difficult to forget.