Fragmented Democracy Medicaid, Federalism, and Unequal Politics

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.

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.

Jamila Michener is Assistant Professor of Government at Cornell University, New York. She is a leading expert in the study of poverty, racial inequality, politics and public policy in the United States. Her work has been supported by the Russell Sage Foundation, the National Science Foundation, the Robert Wood Johnson Foundation, and the Ford Foundation. She is a faculty affiliate at the Center for the Study of Inequality, a graduate field faculty member in the Africana Studies Department, a faculty affiliate in the American Studies Program, and an affiliate at the Cornell Population Center. As a publicly engaged scholar, Michener is also co-leader of the Finger Lakes Branch of the Scholars Strategy Network, sits on the advisory board of the Cornell Prison Education Program, and teaches regularly in local prisons. Prior to coming to Cornell, she received her Ph.D. in political science from the University of Chicago and completed a postdoctoral fellowship as a Health Policy Scholar at the University of Michigan.