Sarah Abend: Medicaid as a Lifeline for an Artist in Michigan

In East Lansing, Michigan, Sarah Abend built her life on hard work, creativity and persistence. She was the first in her family to attend college, and although she entered higher education uncertain of her path, she eventually returned to the passion that had driven her in high school: art. She chose jewelry design to make her creativity economically viable, determined to find a way to contribute meaningfully to the world while supporting herself.

Upon graduating, Sarah faced an economy still reeling from the recession. Saddled with student loan debt and unable to secure a business loan, she couldn’t afford the equipment needed to start a jewelry studio. So, she pivoted. She returned to school and got certified to teach art, hoping that being around young artists would allow her to stay connected to her craft. Over the next six years, she worked part-time teaching jobs but couldn’t find a full-time position that paid enough to meet her basic needs.

In 2013, Sarah took a part-time teaching job that paid her around $17,000 a year. Although the school offered her a health insurance plan, she couldn’t afford it and pay her bills at the same time. She said, “I was fortunately partnered at the time, but you know what? It shouldn’t be a requirement to be partnered in order to survive in this country.” After the relationship ended, Sarah was left with a single income in a system that seemed to require two.

“I’ve been pretty much without health insurance for most of my adult life,” Sarah said. That changed in 2014 when Michigan expanded Medicaid under the Affordable Care Act. “They put me into Medicaid, so I have been primarily in Medicaid since then.” During the times her income exceeded eligibility limits, she lost coverage and had to go without again. When the pandemic struck, her income fell and she requalified. “It’s been a godsend because I have had situations where I needed to have surgery. I needed to go to the emergency room. I mean, otherwise, I would be strapped with medical debt, right? Hundreds of thousands of dollars to have an ovarian cyst removed.”

For Sarah, Medicaid has been more than just a safety net. “It’s been lifesaving,” she said. Last year, she experienced severe symptoms including fatigue, brain fog and heart palpitations. She went in and out of hospitals, seeing multiple specialists. “If I hadn’t had insurance, again, back to how do I pay for that? So, yeah, suffer and then the mental health impact of that, you know?”

Even with coverage, the stigma of needing Medicaid weighed heavily on her. “I’ve been embarrassed to admit that I’m on Medicaid because our country puts this stigma in our mind that like, oh, you’re less than if you’re on Medicaid. You’re a certain type of person if you’re on Medicaid. You’re not trying hard enough.” As a self-employed artist and business owner, Sarah found herself internalizing these narratives. “Here I am trying to hustle as a business owner. Meanwhile, like, oh, yeah, that’s right. I’m part of a certain class that doesn’t really deserve anything and it’s just abuse.”

Without Medicaid, Sarah imagines a life filled with exhausting compromises. “I guess I would be teaching art, which I’m fine with and good at, but is it what I really, really, really, really, really want to do? No. I suppose I might be working three or four jobs. I don’t know, but still probably without insurance.” In recent years, she has transitioned out of self-employment and patched together part-time jobs like pet sitting and cleaning. Still, she doubted she could earn enough to cover health insurance premiums. “There’s no other option when you fall under a certain income. You either go without and suffer and maybe get really sick and die or you get help.”

The proposed work requirements for Medicaid raise even more uncertainty. “If it’s a matter of showing a W-2 and my hours that I’m clocking in, I don’t have that. I have a Schedule C and sometimes contract I-9s.” She questioned whether that would force her to take on additional jobs just to prove eligibility, even though she is already working over 40 hours a week on her business.

Sarah emphasized the inconsistent nature of her income as an artist. Art fairs, her primary income source for part of the year, leave gaps during the off-season. “It’s not cut and dry and clean.”

When she learned that her lawmakers supported cutting Medicaid, her frustration grew. “I guess I want to know how anyone in good conscience can live in a country knowing that their neighbors and citizens and constituents, the people that put them in office, are going to go without health insurance and suffer and potentially die.” She added, “How can you sleep at night?”

Sarah questioned the priorities of a country that leads the world in wealth yet struggles to care for its people. “We are fed these stories that, you know, China is a bad place, and other countries are a bad place and yet they have health care for their citizens. We funnel money to other countries for certain reasons, and their citizens have universal health care.” She called for a system that supports workers and the vulnerable alike. “If we’re going to live in a system where there’s such income inequality and we rely on low-wage work in order to keep the machine of capitalism running, we have got to take care of people. I deserve it. Everyone deserves it.”

She knows others like her who have fallen through the cracks. “I have plenty of self-employed, creative friends that go without health insurance because they’re outside of that $20,000 cap. And it’s like, how much, where do you want us to be? Because even that, like, who can live on $20,000 a year? Not many people. And it’s just really sad.”

Sarah didn’t hide her disillusionment. “I haven’t been a proud citizen of this country for a very long time. And the acts of our government just further prove and prove reasons to not love being here.” A recent quote she heard stuck with her. “No one voted for this. No one voted to take health care away from people. No one voted to take food away from kids and cut SNAP. No one voted for that. Regular people don’t want that.”

She finished with a plea. “Explain to us why you want that, why you’re okay with taking people off the health coverage that their lives depend on and take food away from kids who also their lives depend on. It’s just unconscionable.”