Nestled in the stacks of Olin Library, Prof. Jamila Michener, government, discussed how Medicaid’s geographic and racial disparity affects Americans’ democratic participation during a cozy Tuesday evening lecture.
Selected as a finalist for the 2019 PROSE awards, Michener’s 2018 book Fragmented Democracy: Medicaid, Federalism, and Unequal Politics also secured the 2019 Virginia Gray Best Book Award.
Michener began her lecture by describing the “health policy roller coaster” that American citizens have recently climbed aboard, revealing that in 2010, the Affordable Care Act appeared to offer a “new set of possibilities on the horizon” to some — an optimism that tapered off soon after politics became interwoven with the policy.
“I wanted to understand how people who lived in low-income communities, immigrant communities, and communities of color were experiencing the government — how they were interpreting it and how they were talking about it,” Michener said.
Her interest in the field surfaced while pursuing her Ph.D. in political science at the University of Chicago. During interviews with people on the South Side of Chicago about the American Dream, the topic of Medicaid and its issues for disadvantaged populations emerged.
Medicaid matters politically — the interactions that people have with this social welfare program impact their democratic citizenship, Michener argues in her book. Specifically, Medicaid has implications for communities of color as 50% of Medicaid beneficiaries are Black or Latino, according to Michener.
“A big part of my motivation for focusing on Medicaid is that all of my research really is located at the intersection of thinking about race, poverty and democracy,” she said at the talk. “And Medicaid is a great place to think about that intersection.”
Medicaid users vote less, register to vote less and have less general political participation, Michener found after conducting quantitative research. The impact that Medicaid had on people was varied, but stigma and bureaucratic disentitlement were two common themes in the interviews she conducted.
“They are stigmatized by being part of a program that is for people living in poverty … they feel embarrassed, they feel like they’re treated like animals … you don’t really have any power,” she said.
The underlying theme of her book is the geographic differences in the correlation between Medicaid usage and political participation. Medicaid practices are different from state to state due to the US’ federalist system that grants extensive operational control to states.
Michener told one story of a woman she interviewed who had difficulty getting medical care for her grandmother while she was visiting Georgia from Chicago. Medicaid in Illinois would not pay for the medication that was necessary in Georgia, which affected the women’s political perception and how the government operated.
Another interviewee with a chronic illness said that he wanted to move from Michigan to Arizona with his family, according to Michener. However, Arizona’s Medicaid system is stricter, and he would not have qualified for care there.
According to Michener, Medicaid has a federal baseline but then from there, there’s a huge array of Medicaid benefits that states can offer or choose not to. Michener told one story of a woman who had to have her teeth pulled but could not afford dentures which Medicaid would not cover.
“This is states deciding ‘Well if the teeth hurts pull it out, but we’re not paying for dentures,’” Michener said. “She is in tears telling me about that part of her life, about how she didn’t want to leave the house because she was embarrassed.”
Interactions with a government-run healthcare system impact how citizens evaluate Medicaid and their relative importance and relations to that kind of program. This correlation appears based on the state and their operation of their Medicaid system.
“If you look at the states that are reducing benefits given to the Medicaid beneficiaries versus those that aren’t … we know that the probability of registering to vote, voting, and of broader forms of political participation are all declining along that axis of how much states have reduced what Medicaid beneficiaries have access to,” Michener said.
Because federalism is the mechanism through which Medicaid is delivered to citizens, health equity and political equity are linked, according to Michener. Both the racialized and geographic components of Medicaid experience have resulted in political disengagement in unrepresented and impoverished communities.
“These processes do not affect everyone in the same way, it really depends on where you fall in the broader social structure,” Michener said.
“What people are saying is that ‘I’m learning lessons from these programs about who I am as a member of this political community and those lessons tell me that I don’t really matter so I might as well just leave politics alone,’” she concluded.