Medicaid is the single largest public health insurer in the United States, covering upwards of 70 million Americans. Crucially, Medicaid is also an intergovernmental program that yokes poverty to federalism: the federal government determines its broad contours, while states have tremendous discretion over how Medicaid is designed and implemented. Where some locales are generous and open handed, others are tight-fisted and punitive. In Fragmented Democracy, Jamila Michener demonstrates the consequences of such disparities for democratic citizenship. Unpacking how federalism transforms Medicaid beneficiaries' interpretations of government and structures their participation in politics, the book examines American democracy from the vantage point(s) of those who are living in or near poverty, (disproportionately) Black or Latino, and reliant on a federated government for vital resources.
Table of Contents
1. Medicaid, political life and fragmented democracy; 2. Federalism, citizenship and contextualized policy feedback; 3. Federalism, healthcare and inequity: past and present; 4. The mis(education) of Medicaid beneficiaries in the American states; 5. Pushing back: particularistic resistance in county contexts; 6. Going local: people, places and social policy in the city; 7. Nothing about us, without us: policy advocacy in a fragmented polity; 8. Federalism, policy and political inequality; References; Appendix A: qualitative interviews; Appendix B: statistical tables; Index.