Michigan's Medicaid Bill Is A Case Study In How America Makes Racist Policy

The original version of the proposal would have exempted rural white areas from work requirements.
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Don’t call Mike Shirkey racist. He was just trying to help.

The Republican state Senator in Michigan wanted people on Medicaid to work in order to keep their benefits, but not if they live in counties with high unemployment. He thought it was ridiculous that anyone would call his plan racist.

“I only see one race ― that’s the human race,” Shirkey said in an interview. “I can’t help… where people choose to live.”

The geographical exemption he pitched just so happened to correlate with racial differences in Michigan, benefiting whiter rural counties but not struggling, predominantly black cities, which tend to be located in low-unemployment counties. Shirkey didn’t think that was unfair.

“Don’t tell me that somebody living in the city of Detroit isn’t closer to services and potential jobs in Wayne County than people living in a northern Michigan county are,” he said. “The distances from them to potential jobs are far greater and the services are far fewer.”

After waves of criticism, Shirkey said last week that he’ll abandon the offending provision to avoid an “administrative nightmare.” The state Senate passed the bill last month, but the House hasn’t acted yet.

In defending his proposal, Shirkey seemed to be asking for an exemption of another kind: You can’t call his policy racist if it’s race-neutral in design. But his bill fits a longstanding pattern in America whereby Jim Crow policies get smuggled through the back door, under the cover of euphemism. African-Americans have been systematically shorted on government benefits since the early 20th century through policy variances that were not explicitly racist in intent but had a disparate racial impact in practice.

Take the exclusion of farmworkers and maids from various New Deal programs in the 1930s, including the Social Security Act’s retirement insurance. Ostensibly it was too difficult to collect the needed payroll taxes from agriculture and domestic workers since they didn’t punch the clock in the same way as people in factories.

It just so happened that farmworkers and maids represented 65 percent of the black labor force at the time. Policymakers may not have had an identifiably racist intent, but African-American workers were disproportionately omitted from what is often called the most effective poverty-reducing program in U.S. history.

“The exclusion of so many black Americans from the bounty of public policy, and the way in which these important, large-scale national programs were managed, launched new and potent sources of racial inequality,” Ira Katznelson, a Columbia University political historian, wrote in his 2005 book When Affirmative Action Was White. “The federal government, though seemingly race-neutral, functioned as a commanding instrument of white privilege.”

In an article on the decision to initially exclude farmworkers and maids that the Social Security Administration promotes on its website, public historian Larry DeWitt argued that hearing transcripts and committee reports indicate administrative difficulty was the only reason ― essentially because nobody explicitly said the goal was to exclude black people.

“We cannot impute racism to the Social Security program on the assumption that this provision was designed to exclude from coverage African-Americans if in fact exclusion was not the purpose,” DeWitt wrote.

The occupational carveouts can be found throughout the laws of the New Deal. Occasionally the mask slipped, and the real purpose was laid bare. In reference to the exclusion of agricultural workers from the Fair Labor Standards Act, for instance, Rep. James Mark Wilcox (D-Fla.) insisted on maintaining wage differences between white and black workers.

There has always been a difference in the wage scale of white and colored labor. So long as Florida people are permitted to handle the matter, the delicate and perplexing problem can be adjusted; but the Federal Government knows no color line and of necessity it cannot make any distinction between the races. We may rest assured, therefore, that when we turn over to a federal bureau or board the power to fix wages, it will prescribe the same wage for the Negro that it prescribes for the white man. Now, such a plan might work in some sections of the United States but those of us who know the true situation know that it just will not work in the South. You cannot put the Negro and the white man on the same basis and get away with it.

Around the time of the New Deal, Southern Democrats in Congress, a shrinking but pivotal voting bloc, also protected the racial order of the Southern status quo by insisting on state and local administration of federal programs whenever possible. While the programs themselves might not have mentioned race, their administration was left to local officials — bureaucrats, bank officers, Veterans Affairs staffers — who were more or less free to discriminate as they wished. In the early years of food assistance, for instance, state and local officials could decide whether to provide assistance in a given county. The result: black babies starving to death.

“Many black families were denied welfare, simply because of their race,” Douglas Besharov, a political scientist at the University of Maryland, said in congressional testimony in 2015.

Besharov recalled carrying malnourished children to hospitals during a visit to the Mississippi Delta as a civil rights worker in 1967. “I saw mothers with young children who applied for welfare being offered bus tickets to Chicago,” he said.

States still administer food stamps and Medicaid ― two of the biggest federal antipoverty programs ― but within much narrower federal guidelines. Republicans have consistently supported efforts to give states more leeway, a strategy that in the 1990s sharply curtailed cash welfare for single mothers. States with large African-American populations are now likelier to have stricter Temporary Assistance for Needy Families programs.

Medicaid provides health care to 70 million low-income Americans. This year, the Trump administration has invited states to submit proposals to add work requirements to the program for the first time.

Shirkey was the lead author of the proposal in Michigan. He included a carveout for people in counties with unemployment above 8.5 percent. It would have exempted residents of 17 mostly-white counties, according to one Michigan-based think tank’s analysis, but not populous cities like Detroit that have high unemployment and are mostly African-American.

Program administrators convinced Shirkey it would be too tricky to track unemployment and adjust exemptions on a monthly basis, he said, adding that he would have kept the proposal but for the administrative difficulty.

There are laws on the books now designed to address measures like Shirkey’s. Title VI of the Civil Rights Act of 1964 prohibits ”procedures, criteria or methods of administration that appear neutral but have a discriminatory effect on individuals,” as the U.S. Department of Health and Human Services, which administers Medicaid, says on its website. Had Shirkey’s original bill passed, as Nicholas Bagley and Eli Savit point out in The New York Times, Michigan would’ve needed an HHS waiver that might well have fallen apart under legal scrutiny.

In an email, Katznelson called Shirkey’s original proposal shocking. He said that most lawmakers would probably not harbor the kind of purely racist motivations he turned up in his research on the New Deal, but that the intent doesn’t matter.

“Consequences count irrespective of the motivation,” Katznelson wrote.

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