Republicans Go After Black Residents in Multiple States with Medicaid Work Requirements

Michigan isn't the only state where Republicans are pushing a Medicaid work requirement that’s blatantly racist. Ohio and Kentucky are running the same play, passing a work requirement for Medicaid but exempting mostly white, rural counties. The claim is that the exemptions are for places with high unemployment rates where people simply can’t find work—but cities with high unemployment rates often don’t get the same treatment, because they’re surrounded by (and within county lines of) wealthy suburbs that pull the county’s overall unemployment down. The end effect is that, in what a health law scholar described to TPM as “a version of racial redlining,”work requirements apply to poor black people but not poor white people. The numbers are striking:


The waiver in Kentucky, the first state to win federal approval for a Medicaid work requirement, will have the effect of exempting eight southeastern counties where the percentage of white residents is over 90 percent. The work requirements will be imposed first in Northern Kentucky, which includes Jefferson, the county with the highest concentration of black residents in the state. [...]

Washington Post analysis found that while African Americans make up about 23 percent of Medicaid enrollees in Michigan, they would make up just 1.2 percent of the people eligible for an exemption. Meanwhile, 57 percent of Michigan Medicaid enrollees are white, but white residents would make up 85 percent of the population eligible for an exemption.

The numbers in Ohio are similar—26 counties would get exemptions, and they’re 94 percent white on average. John Corlett, a former Medicaid director for Ohio, points out that these patterns aren’t accidental, either, thanks to a “past history of institutionalized segregation.” And the stakes are high for the most vulnerable:

“The communities most at risk under this scenario are African American, and those communities already have significantly higher rates of infant mortality, lower life expectancy, and a number of other serious health disparities,” he told TPM.

Kentucky’s law is already approved by the federal Department of Health and Human Services—and facing a court challenge. Ohio’s approval is on the way, and Michigan is moving toward passing its law at the state level and going to HHS for approval. This is a gross move to not just stigmatize but actively endanger people’s health because they’re poor … or, specifically, poor and black. 

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