Fragmented Democracy: Medicaid, Federalism, and Unequal Politics
by Jamila Michener
ISBN 13: 978-1316649589
Book description

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.


Recommended on 2 episodes:

There’s Been a Massive Change in Where American Policy Gets Made
Since 2021, Democrats have controlled the House, the Senate and the presidency, and they’ve used that power to pass consequential legislation, from the American Rescue Plan to the Inflation Reduction Act. That state of affairs was exceptional: In the 50 years between 1970 and 2020, the U.S. House, Senate and presidency were only under unified party control for 14 years. Divided government has become the norm in American politics. And since Republicans won back the House in November, it is about to become the reality once again. But that doesn’t mean policymaking is going to stop — far from it. As America’s national politics have become more and more gridlocked in recent decades, many consequential policy decisions have been increasingly pushed down to the state level. The ability to receive a legal abortion or use recreational marijuana; how easy it is to join a union, purchase a firearm or vote in elections; the tax rates we pay and the kind of health insurance we have access to: These decisions are being determined at the state level to an extent not seen since before the civil rights revolution of the mid-twentieth century. Jake Grumbach is a political scientist at the University of Washington and the author of the book “Laboratories Against Democracy: How National Parties Transformed State Politics.” In it, Grumbach tracks this shift in policymaking to the states and explores its implications for American politics. Our national mythologies present state government as less polarizing, more accountable to voters and a hedge against anti-democratic forces amassing too much power. But, as Grumbach shows, in an era of national political media, parties and identities, the truth is a lot more complicated. So this conversation is a guide to the level of government that we tend to pay the least attention to, even as it shapes our lives more than any other.
Jacob Grumbach Dec. 6, 2022 3 books recommended
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