Racial accusations embroil Michigan Medicaid reform debate

Update: Have an opinion on Michigan’s Medicaid work rules? Weigh in quickly.

Are Michigan Republicans trying to shield hard-hit residents in GOP-leaning districts from proposed Medicaid work requirements, even as they seek to impose them on poor people living in Detroit and other Democratic-rich cities?

And, more provocatively, does the legislation, if passed, violate federal civil rights laws by disproportionately impacting African-American Medicaid recipients while giving rural, overwhelmingly white regions a pass?

Michigan’s unemployment divide

State legislators may require Medicaid recipients to work at least 29 hours a week, except in counties where unemployment rates exceed 8.5 percent. Six cities and townships, including Detroit, Flint and Saginaw, have similarly high unemployment rates but would not be exempt.

Would be exemptWould not be exempt
counties mapcities map
  • 17 counties*
  • 303,600 people
  • 88.7 percent white
  • 0.7 percent black
  • Unemployment: 11 percent
  • All counties represented
    by Republican senators
  • Six municipalities**
  • 894,000 people
  • 16.9 percent white
  • 71.8 percent black
  • Unemployment: 9 percent
  • All but two represented
    by Democratic senators
  • *Counties: Mackinac, Cheboygan, Presque Isle, Montmorency, Alger, Roscommon, Schoolcraft, Arenac, Ontonagon, Ogemaw, Chippewa, Emmet, Lake, Alcona, Iosco, Oceana and Kalkaska
  • **Municipalities: Detroit, Flint, Saginaw, Muskegon, Highland Park, and Mount Morris Township

Republican backers of the legislation, which would require Medicaid enrollees to provide proof of work to keep their health benefits, find themselves playing defense as the measure moves through the Capitol. Gov. Rick Snyder, a fellow Republican, has already raised doubts about the bill, largely about its requirement that recipients work 29 hours per week.

Related: Four Michigan maps explain debate over Medicaid reform and race

And now arguments are pivoting to what critics contend are the bill’s stark racial and political impacts.

Senate Bill 897 would allow Medicaid recipients who live in counties with high unemployment — at least 8.5 percent — to count an active job search toward their work requirement. As the bill is written, that exemption wouldn’t apply to recipients who live in cities with high jobless rates, like Detroit and Flint, because their surrounding counties fall below the 8.5 percent threshold.

The result: Counties that would be exempt from work requirements — 17 in all, using the most recent March state data — are concentrated in northern Michigan. Their residents are predominantly white, rural and represented by Republicans in the state Senate. Conversely, most of the cities with high unemployment tend to be black and Democratic-leaning.

“There’s no question (in) my mind that the bill has a disproportionate racial impact,” said Nicholas Bagley, a law professor at the University of Michigan who specializes in health and administrative law. “The question that should worry Michigan’s legislators is whether that means the work requirements plan is legally infirm. And I think it is.”

Most Medicaid recipients subject to the rules typically would need to work, or receive education or training toward employment, to keep benefits.

Supporters say the idea recognizes that Michigan has different regions with different economic conditions, and prevents Lansing from imposing a one-size-fits-all solution.

The provision has attracted state and national attention, with much of the focus on the apparent racial and socioeconomic disparities between who would and would not qualify. And it could get even more attention, if some legal scholars turn out to be right and it runs afoul of federal civil rights laws.

What supporters say

Sen. Mike Shirkey, R-Clarklake, is sponsoring the bill — his district, which covers Jackson, Hillsdale and Branch counties in southern Michigan, is not exempt from the work rules.

Shirkey said he enlisted suggestions for exemptions to account for differing economic conditions across Michigan.

The Michigan Chamber of Commerce, in response to Shirkey’s request, suggested 8.5 percent as used in a 2014 state minimum wage law, said Wendy Block, senior director of health policy, human resources and business advocacy for the chamber.

Block said the chamber also reviewed U.S. Bureau of Labor Statistics data that showed multiple Michigan counties are at or above that rate.

“It’s really not meant to reflect anything but a sign of weakening in the economy,” she said. “Consensus is it’s around that mark where jobs are harder to come by and it would be harder for people to comply with this provision, even able-bodied adults.”

So why not count big cities such as Detroit, whose unemployment rate is 9.5 percent?

Block said it’s easier to track 83 counties than roughly 1,500 municipalities — including cities, villages and townships — in part because the federal government doesn’t break out data for smaller locations.

In an economic downturn, densely populated urban counties could have jobless rates high enough to qualify, said Rich Studley, the president’s chamber and CEO.

“Race was simply not a factor,” he said.

Shirkey went further, telling Bridge that rural residents in northern Michigan deserve more leeway in finding a job than people in places like Detroit or Flint. People in rural counties, he argued, lack public transportation and have to travel farther for work.

“The lower the population, the fewer the jobs. And the lower the population, the greater the distances to the jobs,” he said. “I’ll say that the public transportation system in Southeast Michigan is not as good as it should be, but it’s basically nonexistent in the rest of the state.”

What opponents say

Shirkey’s reasoning fails to understand the transportation challenges facing poor, urban residents, said Bagley, the University of Michigan law professor.

Urban dwellers are less likely to own a car than people in rural areas, Bagley said. And city residents, particularly in Detroit, face steep auto insurance rates that deters car ownership, and a transit system that puts jobs in far-flung suburbs that often aren’t served by buses.

The 17 northern Michigan counties that would be exempt have about 303,000 people combined. That’s less than half the population of Detroit alone, using 2016 estimates.

Bagley said the unemployment exemption could violate a section of the 1964 federal Civil Rights Act, which stipulates that recipients of federal funds — like Medicaid — can’t be discriminated against based on race, color or national origin.

Under the law, it doesn’t matter if the bill was intended to treat minorities differently if the impact of the law does just that, he said.

Emily Schwarzkopf, a policy analyst for the Michigan League for Public Policy, which advocates on behalf of vulnerable Michigan residents, said the only way to improve the bill would be to kill it.

“It seems less about protecting people in struggling areas and more about protecting Republican legislative districts,” Schwarzkopf said. “The barriers to work are no different to someone in Flint, where unemployment is over 10 (percent), than they are to someone in Emmet County. They’re moving a bad bill, and trying to grease it by exempting their constituents. You can't exempt your way to a good policy.”

What’s the status of the bill?

After clearing the Senate last month, the House appropriations committee heard testimony on Shirkey’s bill last week. Gideon D’Assandro, a spokesman for House Speaker Tom Leonard, has said the committee could hear testimony again next week.

But until Republicans can get the governor on board, the House is not in a hurry to send legislation to his desk for his veto.

Shirkey said he continues to negotiate a compromise with Snyder and his staff.

Snyder spokesman Ari Adler told Bridge this week: “The county unemployment rate exemption is just one of a host of issues the governor will continue to work on with Sen. Shirkey as we continue our dialogue on the bill.”

Facts matter. Trust matters. Journalism matters.

If you learned something from the story you're reading please consider supporting our work. Your donation allows us to keep our Michigan-focused reporting and analysis free and accessible to all. All donations are voluntary, but for as little as $1 you can become a member of Bridge Club and support freedom of the press in Michigan during a crucial election year.

Pay with VISA Pay with MasterCard Pay with American Express Donate now

Comment Form

Add new comment

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.


Dena T Arner
Thu, 05/10/2018 - 4:15pm

What a shock that Republican legislators want to exempt their own white rural voters from the conditions they want to impose on every one else - it's all about keeping their jobs so they can continue to drink from the public trough while ignoring their job of helping the citizens of Michigan.

Susan Bender
Thu, 05/10/2018 - 4:57pm

How many people would have to be hired to administer thus stupid piece of legislation that will never hold up in court case after court case. This is no solution for a poverty problem.

Susan Bender
Thu, 05/10/2018 - 4:57pm

How many people would have to be hired to administer thus stupid piece of legislation that will never hold up in court case after court case. This is no solution for a poverty problem.

Sun, 05/13/2018 - 1:11pm

It continues to amaze me that the Republicans continue to push through stuff like this that yields these kinds of racial statistics and then act like 'it's just coincidence and does not indicate any racial bias'. And fail to even think that they will lose in court on these kinds of utter stupidity and waste everyone's time to boot.
I guess they just don't care because their base is fine with it.
Really sad that we have 'government' like this and people so blind.

Wed, 05/16/2018 - 9:16am

Let's just get rid of the exemptions. Afterall, the goal of welfare is to temporarily assist individuals down on their luck until they can rebuild their lives/get jobs again. Or is the goal of welfare to take care of multiple generations of people choosing to not make any effort to succeed on their own? As we all know (those of us that grew up and raised kids), becoming successful in life starts at a very early age and must continue for a few decades of effort, good decision making, and hard work . . . to achieve success. I have never met a person who has put in the effort and is willing to work hard not be able to become self sufficient and at least somewhat successful. In today's economy, one must almost try to be unemployable to not get a job. But I see that often, people coming to our company, wreaking like pot, asking to fill out an application and then asking if we will sign their welfare/unemployment state forms showing that they are "looking" for work (no - we don't sign those documents unless they are at least presentable job-seeking individuals)! They're not looking for a job, they're making the minimum effort to keep getting their hand-out. Nobody that truly wants a job shows up wreaking like pot, looking like they are dressed for a day of laying on the couch watching TV in a hung-over fashion. That is not what ANYBODY who wants to succeed would do. And it doesn't take a college education or even a high school diploma to know this. It is simply their willful gaming of the system.

Wed, 09/25/2019 - 3:16pm

I usually don't comment, but I had to this time. I mean no offense by this, but this comment shows a lack of understanding of what it means to be in poverty and how hard it is to get yourself out of it. Not to discount your anecdotal evidence, but there is far more empirical data and other anecdotal evidence to the contrary. You said you never met someone who couldn't get a job who is looking for one, I can tell you I have met many. It took me 2 full years to land a full time job out of grad school and I had the education, experience, and knowledge of the interview/hiring process. Someone who is in poverty, homeless, etc. may not have the means/money to buy professional clothes, do not have access to the internet or devices to search for jobs, do not have phones to receive calls from a potential jobs to schedule interviews (or have limited minutes on their plans) don't have money to buy paper and a printer or get their resume printed and even if they the money they may not have the transportation to get there. The homeless in particular, do not always have access to showers, soap, razors to shave, or any other personal hygiene or grooming items we take for granted. As your comment so eloquently illustrated, without the correct look, smell, etc. the interviewer is expecting you are judged harshly. There are also those who have a disability who can't work, those who have to take care of someone with disability full time as their primary care giver, etc. Putting up barriers to assistance does not help those gain self sufficiency giving them access is what enables them. These folks lack the social structures and supports that the rest of us take for granted. This isn't to say there are some who might take advantage, but I have not seen any data that supports that most people take advantage, I have seen data that says otherwise, and my own anecdotal stories of people who are trying to get off public assistance or are embarrassed that they need it now and wait until they are in situation far worse if they had only sought out help sooner.

Wed, 05/16/2018 - 9:05am

Then I guess the best solution is to simply not have any exemptions! Our welfare system has become a truly successful carrot/reward system - and it has achieved great success in that area. So much so, that every year, we see more and more people participating - the exact opposite of what should happen with such a system in a non-recessionary environment. Even worse, we see a total disproportionate response to a growing, expanding, booming economy with excess job openings and few people willing/able to fill them - especially in areas of high welfare participation. Is it not the goal of welfare to assist people to return to a productivity working, self sufficient life, become contributing members of society, contributing to the overall good? If that is the goal, the only thing we really can recognize is that it's failures have produced no such results. Instead, we have achieved a multi-generational system that rewards a lack of effort, that has produced the highest birth rate in our country by those incapable of even caring for themselves - yet are encouraged (via financial incentives) to have babies. Help should always go first to those that want to help themselves improve and succeed. What is our welfare system doing to our society? We are procreating at the highest rates by those least capable of taking care of themselves - and certainly failing to raise successful children. What is the end result to our society when this is the largest growing segment of our society? What does the future of our society look like with this picture? Can we honestly say that this system is likely to improve our society - or diminish it?