Theres No Good Excuse For The Racist Impact Of Michigans Medicaid Proposal

Michigan Republicans are pushing a new, Donald Trump-inspired bill that would require Medicaid recipients in the state’s mostly black cities to work to keep their health benefits, but exempt some of the state’s rural white residents from the same requirement.

Republican state Sen. Mike Shirkey, who wrote the legislation, has denied any discriminatory intent. He apparently came up with the bill’s most controversial provision — which has drawn withering scrutiny from legal experts — on the suggestion of the Michigan Chamber of Commerce.

“We were just trying to be helpful,” Michigan Chamber lobbyist Wendy Block told HuffPost. “It was really just a simple suggestion, not one that we’re married to.”

Shirkey did not respond to requests for comment.

Under the bill, Medicaid recipients in 17 mostly white counties, all represented by Republican senators, would be exempt from the work requirements, according to an analysis by the Center for Michigan , a think tank. But Medicaid recipients in the six municipalities with the highest unemployment rates, including Detroit and Flint, would have to work at least 29 hours a week to keep their health benefits. All six cities have black majorities or significant numbers of black residents.

The disparity stems from a provision in the bill that would lift the work requirements in counties with unemployment rates of over 8.5 percent — but not from cities with similar joblessness rates. Since most urban counties in Michigan contain both high-unemployment cities and their richer suburbs, Michigan’s biggest cities would be subject to the work requirements.

Take Detroit. It’s in Wayne County, which had an unemployment rate of 5.4 percent  in 2017. But the rate for the city itself was 9.3 percent , well over the 8.5 percent cutoff for counties. That means its majority African-American population  would be subject to the Medicaid work requirement, while the mostly white residents of high-joblessness counties in the northern part of the state would not.

“The racial consequences are unmistakable,” University of Michigan Law School professors Nicholas Bagley and Eli Savit wrote in The New York Times . The disparate racial impact of the proposal, they said, would be vulnerable to a court challenge because it would violate federal civil rights laws.  

In response to a query from statehouse Republicans, Block said she suggested the 8.5 percent unemployment exemption because of a similar threshold in the state’s minimum wage law . Block told a reporter for the Center for Michigan that federal data made it simpler to go by county jobless rates rather than using smaller geographical areas.

But there’s another big state-federal program that grants exemptions based on more fine-grained data. The Supplemental Nutrition Assistance Program, commonly known as food stamps, allows states to waive the program’s work requirements for counties or cities where joblessness is high or above average. States can also request waivers according to federal “labor surplus area ” designations that account for county-city differences.

Bagley said in an interview that the SNAP model would probably be better. “It might explain why the SNAP program hasn’t run afoul of some the same concerns that we raised with the Michigan Legislature’s proposal,” he said.

Block also said the food stamp waiver mechanism might be an improvement on the one in the Michigan bill, which passed the state Senate but is pending in the House amid the racial controversy and doubts from Gov. Rick Snyder, a Republican. (Snyder backed expanding Medicaid  in the state over the objections of conservative Republicans in the Legislature.)

Several other states have sought permission from the federal government to impose work requirements on Medicaid recipients. Ohio’s proposal would follow the state’s current geographical exemptions for SNAP work requirements. The Center for Community Solutions, a liberal think tank based in the state, has said the proposal raises similar civil rights concerns because the state lifts SNAP work requirements by county rather than by labor surplus area. 

Another solution would be to drop the geographical exemptions altogether. Other states that have pursued Medicaid work requirements, such as Mississippi and Arkansas, have said Medicaid recipients who are complying with SNAP work requirements would satisfy the new Medicaid rule. There are no counties exempt from the food stamp work requirement in those states. 

Republicans in the U.S. Congress and the Trump administration have been pushing to make it more difficult for states to obtain food stamp waivers, making stricter work requirements the centerpiece of their welfare agenda. Currently, most able-bodied adults in Michigan are exempt from the SNAP work requirement. It only applies to able-bodied adults without dependents.

Work requirements have not traditionally been part of Medicaid, which provides health coverage for some 70 million low-income Americans. Earlier this year, the Trump administration invited states to draw up work requirement schemes, which would likely shrink program enrollment if they win approval from the administration.

And while the term “work requirement” may imply that people on Medicaid don’t work, the vast majority of nonelderly, adult Medicaid recipients without disabilities live in households in which someone is working, according to the Kaiser Family Foundation , and a majority of recipients work themselves. 

This story has been updated with additional information about Medicaid proposals in other states.

Correction: A previous version of this story inaccurately characterized the centrist Center for Michigan as liberal-leaning.