In the third grade, Jamila Michener, Government, sent a letter to then New York City mayor David Dinkins asking him what she could do to help her Brooklyn neighborhood. It wasn’t until graduate school, after having long forgotten about the letter, that Michener’s mother showed her a copy of the letter, along with a response from Dinkins’ office.
“My mom always said that this preoccupation I had with race and poverty and politics started a long time ago,” says Michener. “Apparently this is what I was destined to do.” It’s no surprise then that Michener spends her time researching economic and racial inequality and how it affects people’s engagement with the political system.
Political scientists have long known that lower-income Americans are less likely to take part in politics, be it traditional forms like voting or localized forms like joining a community group. Michener aims to better understand why this negative relationship exists, because as she says, it certainly doesn’t need to.
“Maybe the poor will never participate as much as the rich, but they can certainly participate more than they are now,” says Michener. “There are policies and government programs that are adjudicating this relationship. We haven’t given due notice to them, and I hope that my research can help us pay attention to this.”
Medicaid and Ultra-Low Political Participation Linked
Michener is particularly interested in the way state policies and program implementation affect this relationship. In her book, Fragmented Democracy: Medicaid, Federalism, and Unequal Politics (Cambridge University Press, 2018), Michener focuses on Medicaid, one of the largest government programs available today. More than 72 million Americans are enrolled in Medicaid, as of September 2015—that’s more than one in every five of the population.
Michener hadn’t originally wanted to tackle Medicaid—“I was actually intimidated by it,” she says—but as she conducted research interviews for her dissertation, people would often bring up Medicaid, to vent and complain about the program. In her postdoctoral fellowship as a Health Policy Scholar at the University of Michigan, Michener decided to study the health program directly.
By studying three national surveys with tens of thousands of respondents, Michener found a very strong correlation between Medicaid utilization and lack of political participation. Medicaid recipients were less likely to register to vote, let alone actually vote. They were also less likely to partake in civic activities such as contacting a government official or attending a rally.
“It wouldn’t necessarily be obvious that Medicaid would have this impact,” says Michener. She points out that there are other government programs, like TANF (Temporary Assistance for Needy Families), that are more stigmatized, and therefore more expected to have a negative impact on political engagement. “There’s less stigmatization around the Medicaid program—you’re not getting money from the government, you’re getting a really vital resource—so why would this negative impact be happening?”
To answer the question, Michener dug deeper. She interviewed more than three dozen Medicaid beneficiaries and examined how program implementation varies from state to state. What she found was surprising: The impact of Medicaid enrollment is not actually negative across the board. In fact, in some localities Medicaid boosts political participation.
“The context in which the program is implemented really has a huge effect on whether it is a boon or bust for participation,” says Michener. Michener says that Medicaid beneficiaries actually have higher political engagement in states with less extreme geographic disparities in health, recent expansions in Medicaid benefits, and a broader range of Medicaid health services such as dental and vision.
It’s a critical finding, given that when you match people on a range of characteristics, such as race, gender, and economic status, beneficiaries of Medicaid are, overall, less likely to participate politically than non-beneficiaries. Understanding the circumstances when this isn’t the case can help us understand how to best implement a program like Medicaid. It’s especially important today; with the passing of the Affordable Care Act, many states are extending Medicaid coverage.
“The book is really about identifying the ways the Medicaid program is disempowering people so that we can figure out ways to rectify it,” says Michener. “Some of those ways can be straightforward, like changing the application and simplifying the eligibility process. Some of the ways are more difficult because it has to do with inequality in our society more broadly.”
This problem with Medicaid speaks to the larger impact of political inequality in America. “How much inequality can we have and still call ourselves a democracy, where ostensibly, everybody is supposed to be able to participate?” Michener asks rhetorically. When policies send signals to people at the lower end of the economic spectrum that dampen their likelihood of participating, it can negatively affect democracy at large.
The book, beyond giving concrete recommendations on bettering Medicaid, will urge readers to think about the political consequences of inequality in America. “The media focuses a lot on the 99 percent and the 1 percent, and that’s fine. My research is asking about the bottom 10 percent,” says Michener. “The folks whose lives are most constrained are the people who are all the way at the bottom, who are just experiencing qualitatively different things in their day-to-day lives. I hope that I can do that, and do it well, so that we can think about the political standing of economically vulnerable people and how we might change it.”