Research Snapshot: Jamila Michener
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Research Snapshot: Jamila Michener

The main thing that I wanted to show in
the book was that social policies like Medicaid are very different in different
places. There are places where as a Medicaid beneficiary you can have access
to a generous program that allows you to see doctors, to get your health care
needs met, and to do so with relatively little fanfare, and there are
other places where it’s very difficult if not impossible to get care and to
gain access. And that difference is determined by policy and it means the
world for Medicaid beneficiaries, and it also means a lot for how they think
about politics and government. One of the things that I really identify
in my book is the way that Medicaid emerges in people’s lives on a really
local level. And so when I would ask people to tell me about what Medicaid
meant in their lives, they wouldn’t talk about the Federal government and
sometimes they wouldn’t talk about which state they lived in. But often they would
talk about the Medicaid clinic up the street, or the hospital that they
went to and they would talk about who was outside the clinic. Whether there
were people shooting up drugs outside of the clinic. Whether it was safe to go
there. Whether they knew somebody who had gotten robbed nearby. What the building
looked like. Whether it was falling apart. Whether it was dirty inside. And those
places where people go to for care are physical instantiations of the government
in the lives of Medicaid beneficiaries. And those places tell them more about
who they are before the government, in the eyes of the government, and who the
government is to them, than anything else. So a policy like Medicaid is often
structured in a way that creates and undergirds inequality. We expect that
different people will get different things in different places and we’re
okay with that. But the challenge is that that also shapes the contours of
democracy. And so when different people have different access in different
places, it turns out that that also means that they have a different level of
democratic engagement. A different level of inclination to be involved in
politics and in the world and in the communities around them. And so, policy
inequality leads to political inequality. you

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