How Health Disparities Intersect With Economic and Racial Justice

This week, I’m chatting with Malea Hoepf, who is a PhD candidate at the University of Louisville School of Public Health and Information Sciences. In this episode, we dig into the connection between health disparities and economic justice. We also talked about how we, as individuals, can advocate for better health and justice policies and decisions within our own communities and beyond.

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Malea Hoepf Young is a PhD candidate at the University of Louisville School of Public Health and Information Sciences. She also holds an MPH from the UNC School of Public Health, and holds a CHES certification. She has worked on ACA implementation in Kentucky since 2013 as a health educator in refugee resettlement, consumer advocate, and researcher.

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The theme music is called Escaping Light by Aaron Sprinkle. The podcast artwork design is by Maggie’s dear husband, Dan Rader.


Maggie Germano 0:07
Thanks for listening to the money circle Podcast. I am your host, Maggie Germano and I’m a financial coach for women. I’m passionate about helping women improve their relationship with money so that they can take better control of their futures. Part of that journey is making personal finance education more accessible and less judgmental, which is why this podcast exists. Each week we’ll discuss a new financial topic to help you explore how you can make a difference in your own financial life or in society as a whole. If you’re interested in diving deeper into issues like income inequality, debt or money, shame, check out my new money circle community. In this safe feminist space women gathered to talk about money without fear of being judged or shamed. We will break down shame and build community and safety for everyone so that you can find the support you need to gain control over your finances. Visit to learn more and to join the community today. I can’t wait to see you there.

Hey there and thanks for listening. I am your host, Maggie Germano. And this week, I’m chatting with Malea Hoepf who is a PhD candidate at the University of Louisville School of Public Health and Information Sciences. In this episode, we dig into the connection between health disparities and economic justice. We also talked about how we as individuals can advocate for better health and justice policies and decisions within our own communities and beyond. PS, if you don’t currently have health insurance, make sure that you enroll via You have until December 15 to do so. And your income will influence the amount of money that you end up having to pay for premiums. So if you have had your income cut this year, or you lost a job, and so therefore lost your health insurance, this is a great way to make sure that you get coverage again starting January 1. So make sure that you get started doing some research and getting enrolled before December 15. And I hope you enjoy today’s episode.

Okay, welcome Malea. Thanks so much for being here today.

Malea Hoepf 2:23
Thanks for having me,

Maggie Germano 2:24
of course. And so why don’t you just tell our listeners a little bit about who you are and what you do.

Malea Hoepf 2:32
So I am a doctoral candidate at University of Louisville School of Public Health and Information Sciences. And my focus is on health, health promotion and behavior change, and really focus a lot on health literacy. So how people are able to find and process information about health that helps them make the best decisions for for their, their families, their their health. And that can be all sorts of things like health insurance, health, you know, primary care, and so lots of different things fall into that category.

Maggie Germano 3:20
No, that’s great. That’s a really important topic, too. I mean, that’s something the last couple of weeks, I’ve been writing about a little bit of like how to make the right decisions related to open enrollment. And that it can be tricky. It’s not an easy, straightforward process a lot of the time. So I love that there’s a whole kind of field where you’re able to really focus on that literacy piece.

Malea Hoepf 3:44
Yeah, yeah, it’s a it’s a big, it’s a big piece. And it involves, you know, both how health policy touches our lives, our health healthcare system does, as well as all of the other things we have going on in our lives that touches our health, which is much more than just the health care piece.

Maggie Germano 4:02
Oh, yeah, absolutely. And so how did you find your way into this kind of line of study or, you know, line of work? What, what sort of brought you here?

Malea Hoepf 4:12
Yeah, it was a little bit of a circle. I started I mean, I’ve been in public health since undergrad, I knew that that was really what grabbed me. And I was actually started out in international health, like focusing on reproductive health and HIV prevention. So I can say that, um, if, like, 20 something Malea who was just really focused on like, how do you get people to wear condoms? And you know, how do you make sex work safe was knew that like later down the road Malea would be we didn’t everybody demands health insurance and affordable health care, that would be really bored. But I’m, you know, it’s it’s, it’s a real passion of mine. So I worked in an interactive For a while I did Peace Corps, with my husband and Rwanda. And when we came back to the US at the end of that, we’re looking at different jobs and you’re looking to go back and international work, or I’m looking at jobs that would Cuba would be, you know, focused on domestic health. And I ended up working in refugee resettlement for a few as a health educator, and got, and that was working in Kentucky, with really diverse populations here. And that was right around the time that we started, the ACA rollout started. So I got really involved as a consumer advocate on behalf of refugees, but just kind of got into that world and really, and passionate about how how that all went and have have been in that zone, I ended up going to going back into grad school to get my doctoral degree. So I’m in the dissertation phase now.

Maggie Germano 6:01
that’s exciting. And it sounds like you’ve really touched not only in your own work, but just in like seeing the different kind of realms of where you’ve been working, it looks like you’ve touched a lot of the different aspects of health in general health care, and that literacy piece and access piece.

Malea Hoepf 6:21
Exactly. And I, you know, it’s sort of, you know, when I came back from living from working overseas, I felt, you know, struggling about, you know, wanting to work where I felt strongly about, you know, helping refugees understand this really confusing situation, after I’ve been working overseas, and where I didn’t totally know where I was learning the situation. So coming back and helping them navigate these changes, while also having to learn learning a lot myself about our really complicated system. And, and I’m actually from a rural like, I’m from I grew up on a farm, I’m from a rural area. So, you know, care a lot like being at Kentucky, that’s a very rural state, you know, getting to see both the urban and rural challenges and healthcare has been really gratifying to me.

Maggie Germano 7:19
I’m sure that gives you a lot of empathy that you can bring to your work as well of like, having the experience of not necessarily understanding the situation yourself, but then having to help other people understand because I know, I’m sure a lot of people who are like they consider themselves experts from the beginning, they can kind of talk to people in a certain way that might not be super helpful and can kind of alienate people. So I would guess that you’re bringing a lot of empathy to that work as well.

Malea Hoepf 7:50
I try. There’s a lot of cultural competency I’ve learned over the years that has helped me with as much with refugees coming from around the world as it is to you know, focus groups in Appalachia. So for sure,

Maggie Germano 8:04
yeah. Now, that makes a lot of sense. And so it sounds like you know, both with your work in the Peace Corps, and then, you know, public health and working also with refugees, and then with the work you’re doing now, with that health care literacy piece, you’re probably seeing a lot of the connection between access to health care and health disparities and economic issues and economic disparities. Can you speak a little on that of how you’ve kind of seen that connection show up of, you know, access to health care and health outcomes? And that connection between access to money basically,

Malea Hoepf 8:43
right, right. And without making it seem like a conspiracy theorist board full of like, yarn, string

Maggie Germano 8:54
I mean, it might be so yeah, tell us what you know. Yeah.

Malea Hoepf 9:02
Yeah, it’s, it’s, it’s complex. And there’s a line and from 30 rock, I really like where the like quack doctor like doc doctors, the chairman is saying, you know, sciences, whatever you want it to be. And all that is not true public health kind of is whatever you want it to be. Because we have like a framework, all the social determinants of health which are, you know, all of these elements that our affect our health, where we live, work, learn, play, worship, age. And those can be related to the environment we live in. Our civic engagement, our social circles, things like economic opportunity, jobs, stability, housing, security, food security, and things like structural inequality. In discrimination over time, so that’s sort of the framework that I like to hang, hang these ideas on, where there’s lots of different things in a person’s lifespan that impacts their health. And it impacts people’s health, when it impacts people’s health differentially, like based on groups that they belong to. And inequitably that’s where we end up with health disparities where people are different groups, and taken, taken as groups have differences in their health outcomes downstream from those determinants that put them at a disadvantage that make that where they have poor health outcomes than people who have maybe better quality housing, better job opportunities, higher education, less experience of discrimination. So those are where a disparities that are inequitable, preventable and unjust occur. And so you can guess, you know that these happen by differences like race and ethnicity, by immigration status, by disability, people with disabilities, and of course, entered and gender, rural urban divides, and of course, these things all intersect in different ways. So if you’re at the intersections of these different identities, then you know, the, the health disparity might be intensified, and it may be more difficult to overcome those injustices. So that’s the way I think of it.

Maggie Germano 11:48
Ya know, and that, I mean, to me, that makes sense. And I’m part of that is because one of the nonprofit’s I used to work with they did health, a health impact assessments of like certain projects that were coming up. And so I learned a lot related to like, if you build a highway that cuts through a neighborhood, then they can’t walk to the grocery store as easily, or there’s more pollution, or they have less access to your easy access to like their school, because their neighborhood has been cut through. And those are the kind of things like, I never really knew that growing up, and I had a very privileged upbringing as well. So like, that kind of thing didn’t necessarily affect me. And so I wasn’t learning about it. And so I think a lot of people hearing you describe that probably aren’t really aware of that consciously either. And because I think the way we talk about healthcare and our society, and health generally, is very much related to like, personal choice, and just like eating better and exercising and making sure you have health insurance and choosing the right health insurance. And what you’re saying, obviously, is it’s in no way that simple.

Malea Hoepf 13:02
Yeah, I think public health has come a long way. And figuring out that, like, this is not a situation that we can bootstrap our way out of, you know, like there is, I don’t want to discount individual people’s ability to, you know, make positive changes for their health or change their situation. But there that’s on a population scale, it isn’t, you know, it isn’t just to expect that of people who’ve experienced, you know, historical discrimination, and marginalization and injustice, and exclusion. So, there are a lot of factors and we’re figuring out that we need to pull really big levers to change those things and make but create a situation where that’s more or more people can have the things that they need to be healthy. And, and from an in a holistic view of like mental, physical, and, you know, social health. But I think we’ve come further in as a field, in figuring out what we need to do. And it’s such a long way to go and figuring out how to do it effectively. Because it takes a lot of power to move those levers,

Maggie Germano 14:30
of course, because they’ve been in place for a while and it’s not something you can just once there is that recognition, it can change overnight, but that recognition is really important. Like you were saying, you know, I totally agree that I don’t want to discount the personal decisions people are capable of making because I think we can kind of give people some, like understanding of their own power of when what they can do when they can, but I think ignoring those bigger societal and systemic issues is, like you said, very unjust, very unfair. And it ignores a huge part of the puzzle that, like you said, is moving the levers around and kind of causing some of those issues. So making sure to talk about both. And then figuring out the solutions is really important.

Malea Hoepf 15:17
Yeah, exactly.

Maggie Germano 15:19
So you started mentioning some, some of those intersections and some of the things that are kind of playing together when it comes to health outcomes and some of those other disparities. Can you talk a little bit about specific examples that you’ve seen, that you’ve helped people work on or work through, of how some of that shows up in people’s lives in a way that maybe is not as obvious to kind of the more general public.

Malea Hoepf 15:50
So I’m based in Louisville, Kentucky, and one of the ways I think about this a lot is, we have a really great part of our health department. That’s the the Center for Health Equity. And they take kind of a big picture, look at our city and have lots of great maps. And they break down health outcomes for different parts of the city in a way that you can compare across neighborhoods and the part of the city with the the most, the most health challenges, they have the lowest life expectancy, they have higher rates of heart disease, higher rates of childhood asthma, they have higher rates of cancer deaths, though that is the part of the city that is historically been African American, it is it lines up right up against the old redlining maps of the city where they enforced segregation. So those are places where there are, you know, where there has been concentrated poverty, there are food deserts, there have been, like safety and crime issues, issues of police violence in those areas, there have been proximity to coal, fire power plants and other industrial zones that affect people’s health. And in late, and lately, you know, issues around gentrification in parts of the city where people? Are there development projects that don’t always have adequate community buy in, because there’s been, you know, a really long period of distress. So there’s a 13 year difference in life expectancy between that part of the city and the wealthiest part of the city. So I think it lays it out in pretty stark terms. in those ways, and yeah, it’s just like these patterns of inequality patterns of lack of economic opportunity. It just limits and can change people’s the things that people need to be healthy.

Maggie Germano 18:17
Yeah, absolutely. I mean, you mentioned access to food, being exposed to violence, whether it’s police violence or otherwise, and the pollution piece and the economic opportunity. I mean, that’s just so many different things, working against a community in a city where other parts of the city, they’re having completely different experiences. I mean, the fact that there could be that huge of a life expectancy gap among different neighborhoods in the same city is something that that just honestly blows my mind.

Malea Hoepf 18:52
Yeah, yeah. Place, place matters. And you know, you can do lots of things to try to stay healthy. But it’s not going to change the air that you’re breathing, you know, if you’re living in one neighborhood versus another.

Maggie Germano 19:08
Right. And that’s something I think people don’t think about too. And then related to you know, that the air you’re breathing, and then you mentioned, like, the economic opportunity, if you can’t afford to move, because I feel like a lot of people, privileged people or people who are kind of ignorant to these sorts of issues could be like, Oh, just move somewhere that has cleaner air, and it’s like, well,how do you do that? If you can’t afford to move or you can’t afford? Like, you mentioned gentrification, like certain places, getting more expensive and pricing people out so that it’s not possible to be moving. Or maybe you’ve always been near your entire family and you’re not trying to just completely pick up and relocate away from your family and

Malea Hoepf 19:49
What are you trading off if you’re moving.

Maggie Germano 19:51
Exactly, yeah. So it’s so much more complicated than just, you know, the reaction some people might have just just just move wherever safer and healthier. So you mentioned that you you’ve done some work with, you know, when the Affordable Care Act was rolling out, and it sounds like with the work that you’re doing with your PhD now is related also to health care policy and literacy related to that. So can you talk a little bit about how health care policy overall kind of impacts our health outcomes on the day to day and kind of what, what we have access to and what our choices are?

Malea Hoepf 20:32
Yeah, totally. Because I mean, when you talk about health care policy, I mean, the big one is, is the ACA, and how, how it’s implemented state by state, because it can be, it can be very different. So there’s some peat and it effects. I mean, if you haven’t dug into it, I know if you realize how big the law can be from, like calorie counts on restaurant menus to, you know, requiring employers to provide a place for a woman to pump to and covering breast pumps on down to changing ways that insurance companies work. And one of the most well publicized, you know, ways, the ways that the ACA really, obviously impacted people’s lives is this opportunity to buy insurance for people who didn’t have access through their employer, which is how most people get their insurance and Medicaid expansion in which states could opt in or opt out of do that Supreme Court decision. So that, you know, did a lot went a long way to reduce the uninsured rate overall in the US. It the low point was in 2016. And we’ve crept up since then. But it’s still not as high as it was prior to the ACA, where we were seeing increasing costs in health care. And this really high uninsured rate that was, you know, it’s insured rates and our health outcomes. They aren’t, you know, completely tied together, you know, our health as much bit more than our health insurance access, but they are related. And so it’s, it’s hard to exactly articulate how much that helped health outcomes, because you know, there is kind of a lag over time, it’s hard to say, with precision, exactly what it does to have health insurance. But we know, it’s positive, like, points are positive. And you know, just the kind of thing that takes a long time to have really clear outcome data on but we know it’s good. And Kentucky, was, it was really exciting being here, when that was all getting rolled out, because we were the only southern state who went all in on all in on Medicaid expansion and having our own state based exchange, we had a website that worked really well, as opposed to the rollout, we have this really well done targeted marketing, you know, it was everywhere, all the opportunities that we had, that you had to sign up for different kinds of health care. And it was really encouraging for people to sign up for Medicaid. And you went through the same website for Medicaid, as you did for purchasing insurance as a way to kind of de stigmatize, you know, signing up for that. So it and we had, I think we had the biggest drop in our uninsured rate in the country. So which was really exciting. So

Maggie Germano 23:55
that’s amazing. That must have been, yeah, just really cool to witness especially just in the work that you do and the work that you’re passionate about being able to be part of a state that obviously understood that this was important and wanted to provide this to its citizens.

Malea Hoepf 24:13
It was very exciting. And consumers had a lot of consumers and advocates had a lot of input and into how it worked. Because, of course glitches is, it is still the US healthcare system. It is still complex and complicated and expensive and confusing and glitchy. But we had a seat at the table 2015 we got a different governor and got to see kind of not completely fall apart but really change and become more difficult. Virgin he only had one term. And last last and so we’re kind of on a positive trajectory. Again, I’m at the different governor is to kind of trying to put things back in place. So that’s also gratifying to see what

Maggie Germano 25:01
That’s good to hear. I was gonna ask. Yeah, yeah, I was gonna ask if that being all in stayed the same. So it sounds like it’s kind of gone back and forth depending on who’s the ultimate person in charge.

Malea Hoepf 25:14
Exactly. And it’s, you know, and it ended up. It was Poppy. It was popular. There was a lot of the folks who were who were doing enrollments around the state would, you know, often say they’d have people coming in saying it like we had it was ky anything any CT, so Connect? So lots of people coming in like, well, I don’t like that Obamacare, but I want Connect, I like connect a lot. I just don’t want Obamacare. And so that was the common refrain. But

Maggie Germano 25:53
yeah, so it’s often a lot about language, because like you were saying, even if it’s not, even if you can’t necessarily say all of the ways having more access to health insurance really does impact people. It To me, it’s obviously going to be a benefit. Because we know that health costs are often a top reason for bankruptcy or for you know, falling into debt and having financial difficulty. And so the more access you have to coverage that allows you to not only go to the doctor if you need to go to the doctor, but that if there’s an unavoidable issue, like an injury or an illness or serious illness, obviously, we’re in the middle of a pandemic right now. So some people can’t avoid it, having access to coverage so that you don’t have to pay for everything out of pocket or just, you know, be saddled with debt for the rest of your life. It’s going to help people more than it’s going to hurt people.

Malea Hoepf 26:51
Absolutely. Yeah, that drug cause, I mean, and before we were in the middle of a global pandemic, I mean, we still had an opioid epidemic going on here and in that hasn’t gone away, like there’s so many different challenges that healthcare can really change people’s lives and keep people alive, make them able to participate in the world. That’s so important and made possible by access to health care.

Maggie Germano 27:24
Yeah, I totally agree. And so we, you know, we’ve talked a little bit about the health insurance piece, what are some of the other solutions that you kind of see through your studies through the work that you’ve done, and the solutions to some of those healthcare disparities we’ve talked about, and those economic disparities have, you know, not related to the personal decisions people can be making, but what are some of those bigger broader solutions that you kind of see?

Malea Hoepf 27:55
I mean, I think keeping moving, like ultimately keeping moving towards a equitable healthcare transformation, health systems transformation, you know, making a system that works for everyone is our you know, the ultimate goal, like having a system where everybody’s right to healthcare is, realize where it isn’t a financial hardship to get sick and making sure it’s equitable along all sorts of different lines, and it’s high quality health care that’s culturally competent, and addresses implicit bias in health care. That’s, it’s a big, it’s a big ask, but you know, there’s lots of different ways to move towards it. And the ACA was a really important step in a long chain of attempts at health care reform. And there’s a long way to go. So making sure that that stays in place and is strengthened and expanded is really important right now with the, you know, political situation being what it is. So it’s like holding the line and moving it forward towards justice, and healthcare pieces really important. There are also, you know, ways to, and I think it’s also important to think of it holistically to so movements towards racial justice, economic justice, following the organizations that are, you know, led by the most impacted groups in society like people of color, disability groups, advocacy groups, following their lead on The issue, the political issues and our policy issues that are important to them is really important.

Some of the other pieces that are have bipartisan support that might be possible are things like, you know, getting, like dealing with reducing drug prices and surprise billing legislation where I don’t know if your listeners are familiar with that. But you know, there’s legislation out there to protect people from bills that they get when something when their anesthesiologist isn’t isn’t covered by their health insurance. And suddenly they’re getting the full bill for that, or, you know, they’re referred for surgery that suddenly isn’t in their network and their health insurance, and they’re dealing with 10s of thousand dollars in bills that they didn’t plan for, even though they thought they knew their insurance. Insurance Plan. Well, so those are some of the policy things that are floating floating out there and could really help people but but are part of the bigger picture?

Maggie Germano 31:08
Yeah, I mean, I, I’m expecting my first child in the beginning of the neck in January. And that’s something I’ve been thinking about a lot with, like, making sure that everyone in the hospital is like actually a network because I’ve heard these horror stories of like, yes, the hospital is in network. Yes, your doctor that you knew, and that you were planning on seeing was in network, but like you said, the anesthesiologist was not or this other person who was in the room was not, and then you get these bills, and it feels like you can’t do anything about it, or you can’t fight it, because it’s like, they kind of shrug their shoulders like, Oh, it’s just the way it is. So yeah, that’s something I worry about. And I’m sure it’s really impacted a lot of people. Yeah, so how can folks do their part to kind of advocate for some of these legislation, some of this legislation and some of these policies that are either currently in place like the ACA, because we’re kind of seeing we’re seeing that threatened? I know, the Supreme Court is hearing cases on it now, which is scary. But then also those other pieces of policy that are out there, that haven’t been passed yet, how can folks kind of start advocating for those things?

Malea Hoepf 32:20
Well, I mean, definitely contact your, your, your senators and representatives, this is something that they should be hearing about that is the health care issues that are important to their constituents that the support the support the ACA support, just let them know that health care issues that are important to you, and that equity is important to you. And also, you know, a lot of a lot is happening at, you know, state and local levels. So did your state expand Medicaid is is that? If not, is that something that you can contact your your state representatives about and let them know that this is important. you know, also local issues of, you know, is zoning done equitably is How is your health? Does your health department look at? How are they looking at Health Equity? How, how are your local policies, addressing health issues and health disparities in where you live?

Maggie Germano 33:36
Yeah, that’s super helpful. So both the federal and local level, because I know I mean, this year with the election and all of the different issues that have been coming up related to police violence, and defunding the police and those kinds of movements, it’s become very clear that there’s more of an impact at the local level, often than at the national level, especially just in terms of time, and how long it takes to kind of get that sort of change. So not just focusing on your congressperson or your senator, but being in touch with the state representatives and the local representatives, I mean, people who work at the health department, you know, they probably want to hear from people in the community and want to work with the community to improve outcomes and things like that. And I feel like we don’t talk about that a ton of like reaching out to those people and really making yourself known and your wishes known and getting involved somehow, maybe, you know, you can be on some kind of task force or something like that.

Malea Hoepf 34:39
Yeah, yeah. Down to I mean, our I mean, I talked about the inequality here in Louisville. I mean, probably, you know, we had you know, we’re having a huge reckoning on race and inequality because of Brianna Taylor’s killing here in the city, and It’s it’s, it’s it’s forced the city to have a lot of heart, you know, a lot of hard conversations. And, you know, we’ve been, you know, asking people to to get engaged with their Metro council representative and, you know, in touch with the mayor and, you know, take a hard look at how our city’s developing and, and working or not working for all of its citizens. So, you know, these, I think we’re seeing really clearly right now, both with COVID. And with cases like granite Taylor’s that, like, we’ve got a lot of reckoning to do around building equity for a better future for everybody, like when the system works. I mean, I think about this a lot in the healthcare system, that when it works for people who are the most marginalized, the most vulnerable, it works better for everyone, when it’s when the healthcare system is, you know, easier to understand when information is clear, when billing is clear, when you can get the information you need, and whatever language you speak most comfortably. Like when it’s built to be responsive to those needs, it works better for everyone.

Maggie Germano 36:22
Right, and I think that that’s something that gets missed a lot of the time. I mean, there’s a conversation happening right now about student loan forgiveness, or, you know, canceling student loan debt. And I’m seeing a lot of arguments on Twitter in particular of like, but I paid my student loans, or I didn’t even need student loans. And so like, That’s not fair that these people get this, it’s like, it would actually help everyone, if a vast amount of people in the country were not being saddled with debt that they were struggling to pay, you know, they’d have more money to kind of support themselves on an everyday basis, or be able to invest in themselves and their futures. And it’s the same with any part of the system of like, just because something affects someone else more than you doesn’t mean that fixing that thing isn’t going to help you. In fact, like you said, it will more than likely make things better for you, too. So we should all be thinking about this and pushing for these things together.

Malea Hoepf 37:19
Yeah, and I’ll say, you know, I work, I work in health literacy, I’ve, you know, done research, I’ve done, you know, trainings for people to help understand their own health insurance and talking with my colleagues and that work in the same field, we’re always going back and forth, like, Okay, this thing happened to me. And, you know, I did the dumbest thing, or I made the this mistake, or I had this weird bill, you know, it happens to all of us because, you know, like dealing with your with your healthcare is very situational. And like, while you may feel like you may be prepared in one area of, that you’re really familiar with, or you’ve been through before, you may be thrown into some other some other situation. And even though you know, the questions to ask, and you know what to worry about, you may not be in a position to speak up about that. I know, last, about a year ago, I was very pregnant and had a three year old with me and my husband had chest pains, and we had to go to it. We ended up in the ER, he ended up being admitted overnight, everything was okay. But I’m sitting there trying to keep the three year old from pulling out his IV as he’s messing around with all these machines for hours and in the hospital. And I’m going through my list of questions that I that I knew I should be asking about what was covered and what was not. And I’m like, I’m just not even, I don’t have, like, I’m so worried. I’m so focused on my kid that I’m not, I’m just not even going to go there right now. We’ll deal with it. Later when things are settled. And we got this weird bill that said, Oh, you it wasn’t really necessary for him to spend the night in the hospitals. So we’re not paying this with a bill which went away without me having to do any after the initial freakout. They like, Oh, we made a mistake. But you know, completely talking to my other like health literacy friends about this. I was like, you know, we know all the thing, like we know so much of the things to be concerned about, but you can still get, you know, hit with all of these confusing situations. And it’s not easy for for really anybody and then of course, you imagine, you know, one of the refugees I’ve worked with or someone who was even less comfortable speaking up with a doctor because of historically bad interactions, you know, between between patient provider A patient provider interactions that are tinged with implicit bias against certain racial groups. Like, if it’s if it’s difficult for me to say like, I’m getting my PhD, and it’s hard, then then it system isn’t working.

Maggie Germano 40:17
Right? I thought about that when a few years ago, I enrolled in the marketplace health insurance through my state. And I found it so complicated and confusing, even though like, they had their own website as well. And there were people I could talk to, there’s so much information, but I still found it confusing and overwhelming. And I kept thinking, like, people who are not who English is not their first language, or who they’ve never been through the American healthcare system before. Like, how are they supposed to do this, if it’s that hard for me, when I have like every advantage to figure this out, and and know what I’m doing. And it’s still difficult for me, I think about that a lot with taxes too. Like, I went to college, my taxes aren’t even that complicated. And I still feel like I have no idea what I’m doing, how do other people figure this out? Obviously, like you said, If that’s the case, the system is not set up the way that it should be set up, so that everybody can figure out what they need to do and just kind of, you know, generally get by and understand what they need to do. And I mean, a lot of people don’t even know that if you get a bill, for a medical expense, that you don’t just have to pay it, you can call and question it, you can make them, you know, justify that to you, or make them run it through your insurance again, or you can set up payment plans, if it really does end up being that you needed to pay it. Um, but yeah, I think with the differential and kind of power that we see, when we’re dealing with a healthcare system, or we’re getting a bill in the mail, it’s like, Oh, God, I obviously have to pay this. And most people don’t know that that’s not necessarily true,

Malea Hoepf 42:01
right? Like I completely, like learning that you can negotiate and that you can ask questions, is super important. getting prepared before you’re sick? And to kind of figure out what your insurance does what it covers. And when it doesn’t, figuring out what questions you need to ask, when something comes up, you know, put you in a much better situation, when you’re, then you know, when you have an emergency or when you get sick. So you’re not having to think about that stuff. But it’s still things, things pop up. And you can go back they have there’s a lot of discretion that people that, you know, billing people do have to set up payment plans to forgive something to double check that the coding was done correctly. I guess it’s it’s scary, but it’s not like it can be scary. But it’s possible.

Maggie Germano 42:58
Yeah, I totally agree.

Malea Hoepf 43:00
And even you know, when something’s really egregious, and when there’s, you know, like a really scary surprise bill, that where there’s a lot of money that that’s not covered, and going to the press, going to reporters and saying, you know, this, this happened to me and having them chase down the billing people to you know, like, I really love Kaiser health news does a bill of the month, where they go through some kind of bill that, that people have gotten to try to figure out all the things that happened, if there’s anything that they could have done ahead of time to ward it off. And a lot of times, they’ll just, you know, when a reporter is asking questions, they can, you know, find ways to forgive, you know, some of this bill or find out, you know, ways to write it off. So

Maggie Germano 43:53
that’s really good advice. Yeah, cuz I mean, and that’s something that I mean, I when I work with my coaching clients, if they get a bill in the mail, whether it’s health related or not, that they don’t understand, or they don’t know why they’re getting this bill, or they paid that bill. And so that, why am I getting this? asking those questions, like you said, and being even like, Can you prove to me that I actually owed this if if they don’t have proof, or if they can’t actually justify it, then they can’t necessarily force you to pay that. And so just like you said, asking follow up questions, pushing for a little bit more information, asking about the coding, making sure they ran it through your insurance. But then yeah, ultimately, also going to the press. It sounds like there’s certain reporters that want to be tracking down these kinds of stories, because it’s, it’s a big deal and it affects a lot of people and it’s fundamentally unfair.

Malea Hoepf 44:52
Yeah, and I mean that and that goes back into the, the economic justice piece that if you’re on top of like encountering citizens If you’re, you know, in a situation where there’s, you know, where there’s a wealth gap, a historical wealth gap that’s due to structural inequality, like in different racial communities, then when you’re asking people to absorb a hit for medical expenses, when there isn’t a lot, when you don’t have financial reserves to deal with that, then it’s another huge justice issue. Like if people are, you know, systematically had excluded from being able to build wealth, then asking them to absorb these emergency hits on the resources is is, you know, potentially devastating.

Maggie Germano 45:54
Right, it can up and everything going on in your life, which can make a really long term, if not lifelong impact for people. So is there anything else that individuals can do actions they can take, I mean, you mentioned advocating for different policies at the local and state and federal level, you’ve talked about how they can stand up for themselves a little bit more when it comes to their own health experiences and billing experience, or the Is there anything else that you recommend folks can do just in their own capacity to help make these systems a little bit better?

Malea Hoepf 46:33
I mean, I think, working on the big picture watching this space, because I mean, there’s so many changes that may have been or may not happen, you know, like, this is an evolving area. And so, you know, keeping an eye on it, and, you know, trying to, you know, bend that arc towards justice. And health care, is really important, I think. Just talking to people about it, you know, talking to other people about their experiences with healthcare and insurance can be really eye opening and interesting. When we were doing did some health literacy, focus groups with, with people, they’re mostly on private, their own, like employer insurance. But like, kind of working class folks were not in poverty, but not super well off, you know, they, they got by with a lot of just depending on friends and relatives who had more experience than them. Like, it’s, there’s a lot of experiential learning that happens when you’re going through when you’re working through healthcare issues, that like, you may know what your deductible is, and what your network is, but, you know, dealing with these things, like figuring out billing and codes, and you know, what you should look out for when if you have to go into the hospital, you know, people really help each other in an important way. So, you know, I think opening up about this confusing, difficult thing can be really helpful for you and for other people. And, and, and the more people realize what, what the system is like, and the challenges that are there, I think the more people who can become more engaged in making it better.

Maggie Germano 48:28
Yeah, I think that’s a really good takeaway, too. Because it can also make you realize, like, Oh, no, the system’s just really confusing and complicated. It’s not just you, it’s not that you were making bad decisions, or you’re just fundamentally not smart enough. You can see the other people are going through the same things that can help take some of that anxiety away from it, too.

Malea Hoepf 48:49
Yeah, normalize that. This, this system is hard, hard to deal with. And it’s not it’s not made to be easy. So it’s not made for optimal health. It’s for something else, so yeah.

Maggie Germano 49:07
So is there anything else that you haven’t covered yet that you want to make sure listeners take away from this conversation?

Malea Hoepf 49:14
Now, just, I think, just staying engaged and and, you know, paying attention to the people who are most affected by, like, change in policies like paying attention to what the immigrant community needs, because they’re not eligible for the same kinds of health care coverage. That happens, like pay attention to, you know, what grassroots disability communities are looking for, because, you know, their actions when they were trying to overturn Obamacare repeal and replace pieces that happened earlier. They were so instrumental in in fighting those efforts. For us, that would have made things a lot worse. for health care access. So communities, you know, what communities of color are doing in their grassroots organizations around health, keeping an eye on that space is is important. wear a mask.

Maggie Germano 50:20
That’s a big one. social distance. Great. Well, thank you for that. And is there anything that you want to promote, whether it’s an organization that you really support or anything that you’re working on, or that you know of that you want to make sure people know about and can get involved?

Malea Hoepf 50:39
in my heart is still kind of in reproductive justice, even though we’ve done so, you know, groups like sister song. I think birth and reproduction is an area where like, health disparities are so stark and tragic. And they, they they really highlight and do great work around that. So especially if you’re interested in reproductive health and birth. Birthday goodness. That’s, that’s a great organization to to look into and support.

Maggie Germano 51:18
Wonderful. Well, thank you. I really appreciate that. And I’ll share all the resources that you mentioned as well. If folks have any follow up questions for you. Is there a way they could reach out to you?

Malea Hoepf 51:30
Yeah, I am at on on Twitter. Mama, jack.

Maggie Germano 51:35
Great. Yeah, I’ll put those in the show notes as well. So thank you so much for taking the time to chat today. I know, you’re probably very busy working on your dissertation and taking care of your kids and all that everything that’s going on right now. So I really appreciate you taking the time to have this conversation. I think this is a really important topic that you know, like we’ve discussed, it really touches everyone.

Malea Hoepf 52:00
Great. Thanks for holding it up. It was great talking to you.

Maggie Germano 52:02
Of course you too. Thank you so much for listening to the money circle podcast this week. If you like the conversations we’re having here and you’d like to go even deeper. Join the new money circle community. In this safe intersectional feminist space. We will break down money shame and build community and safety for everyone so that you can find the support you need to gain control over your finances. Visit to learn more and to join. If you’d like to get more connected with me subscribe to my weekly newsletter at to learn more about my financial coaching services, my speaking and workshop offerings or just to read my blog visit You can also follow me on instagram and twitter @MaggieGermano. I look forward to hearing from you. Bye bye