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It seems reasonable to ask able-bodied Medicaid recipients to fulfill work requirements. It especially seems reasonable to those of us who receive health insurance through our employers.

What’s unreasonable is to exempt some Medicaid recipients from work requirements while maintaining the requirements for people in a different geographic area. Especially when the exemptions have undertones of racism.

In Michigan, state lawmakers are pushing a plan that would require Medicaid recipients (with exceptions for the disabled, elderly, and a few other selected populations) to work or search for work at least 29 hours each week, reported Thursday. If they fail to meet the work requirement, they could lose Medicaid coverage for a full year.

Anyone who’s been unemployed for an extended period can tell you that you have to regularly demonstrate you have searched for a job or risk having your unemployment benefits cut off. Michigan’s Medicaid proposal seems, at first glance, to be an extension of that idea.

But the Michigan plan comes with a twist: People who live in counties with higher unemployment rates — above 8.5 percent — are exempted from the requirement. That is likely to lead in practice to rural whiter counties, where unemployment is higher, getting a break from these work requirements while urban areas with a higher share of black residents would still be subjected to them. Which means that black Medicaid enrollees would be more likely to lose their health insurance.

Earlier this year, when President Donald Trump’s administration first said it would approve Medicaid work requirements, the Centers for Medicare and Medicaid Services said it would allow states to account for local conditions, such as high unemployment in certain areas or other factors, to provide exemptions from a work requirement.

Rural areas, more likely to be white, could have fewer job opportunities, less robust transportation, and fewer social support services, all things that might lead a state to provide an exemption from the work requirement. The result, intentional or not, is that black people on Medicaid — because they are more likely to live in urban areas, where those grounds for exemption are less likely to be found — could face a higher burden under these waivers.

“All of these things are potentially much harder to come by in rural areas,” George Washington University’s Sara Rosenbaum said. “Because of the demographics, you could have situations where the populations required to work are disproportionately African-American.”

The Michigan plan, which has been passed the state Senate, seems to present exactly the kind of situation Rosenbaum describes:

Cheboygan County — which is represented by state Sen. Wayne Schmidt, R-Traverse City, one of the authors of the Medicaid work requirement plan — is 93 percent white, 0.6 percent black, and had an 18.7 percent unemployment rate in March. It would be exempt from the work requirement

Genesee County, home of Flint – which is still reeling from the damage done to its water supply by the state’s decision to switch its water source to the corrosive Flint River – is 75 percent white, 21 percent black and has a 5.8 percent unemployment rate. It would not be exempt from the work requirement

Wayne County, which includes Detroit and surrounding areas, is 55 percent white, 39 percent black and has a 5 percent unemployment rate. It would not be exempt from the work requirement, even though the unemployment rate for the city of Detroit is at 8.5 percent.

A comparison of Census Bureau data and the state employment database shows that all of Michigan’s counties with an unemployment rate above 10 percent are at least three-quarters white, with most of them pushing 90 percent.

Under Schmidt’s plan, Michigan’s counties with the largest black populations would be subject to the Medicaid work requirements, but its white-majority counties with high unemployment would not. The effect would be to give a break to poor whites while not giving the same break to comparably poor blacks.

We hope Michigan Gov. Rick Snyder can see the obvious racial disparity in the Senate bill and will exercise his veto power if this bill reaches his desk. Medicaid work requirements should be founded on a recipient’s ability to work, not the color of his or her skin.


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