Many recent health reforms in the United States are imbued with neoliberal responsibilization rhetoric, which encourages individual responsibility and reduced dependency on the state. This ideology is evident in waiver-modified Medicaid expansion programs which include personal responsibility requirements such as increased cost sharing and behavioral incentive programs. In this article, we explore the limits of responsibilization rhetoric in the context of the lives of a group of Medicaid-qualified people in Michigan. We consider the health needs and challenges they face, how they view and respond to such notions of responsibility, and their access to healthy behavioral choices such as exercising, eating healthy foods, and seeing a doctor. We found that most already embraced a desire to take responsibility for their health, but due to the synergistic impact of a variety of barriers—notably unreliable and changing health insurance coverage, fluctuating low-wage employment, and limited access to health resources—healthy choices were often inaccessible to them. Rather than framing beneficiaries as being to blame for their own poor health, health policies would be more effective if they were designed to directly mitigate some of the social and structural factors which synergistically act as barriers to health seeking.

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