Michigan Republicans' plan to require some recipients of government health insurance to work would disproportionately affect black people, a Washington Post analysis of new data from state health officials reveals.
The proposal would exempt people living in counties where the unemployment rate tops 8.5 percent, a provision GOP lawmakers say is aimed at protecting those living in areas where job opportunities are scarce.
Medicaid enrollment data provided to The Washington Post by the Michigan Department of Health and Human Services shows that this exemption would overwhelmingly benefit white people while leaving the work requirements in place for all but a sliver of the affected African American population.
Without the exemption, the work requirements are projected to apply primarily to approximately 700,000 Michigan residents enrolled in Medicaid under broader eligibility rules passed under Gov. Rick Snyder (R).
African Americans make up about 23 percent of that population, but they would make up only 1.2 percent of the people eligible for the unemployment exemption. White people make up 57 percent of the total potential affected population, but they make up 85 percent of the group eligible for the unemployment exemption, according to an analysis of the state's data.
Michigan's health department provided The Post with Medicaid enrollment data by racial and ethnic group for every county in the state. This analysis was based on the population enrolled via the state's Medicaid expansion, which health experts say is the group expected to be subject to the work requirements, because enrollees on “traditional” Medicaid are likely to be exempted. While it's possible, some experts say, that a small portion of the traditional Medicaid population would be affected by the work requirements, including that population in the analysis would not change the racial composition of the exempt group by more than about one percentage point.
Republican proponents say the unemployment exemption would help vulnerable Michigan residents retain health insurance if they cannot find work near their home. Critics say it primarily helps white residents in rural parts of the state while failing to account for the employment barriers African Americans face in cities with high jobless rates.
The plan would not exempt Detroit and Flint, two cities with unemployment rates well above 8.5 percent. Both cities are in counties with unemployment rates below the threshold, according to government statistics. About 44 percent of Michigan's black residents live in the two cities.
Failure to meet the proposed work requirements could result in Medicaid enrollees losing their insurance, in some cases keeping people off the program for up to one year.
Medicaid is a federal program administered by states. Earlier this year, the Trump administration said it would give states conditional permission to impose Medicaid work requirements, a first in the program's history. The administration has approved waivers for four states, and at least six other states have their own plans under federal review, according to MaryBeth Musumeci, associate director with the Program on Medicaid and the Uninsured at the Kaiser Family Foundation.
Work requirements for recipients of social programs are not unique to Medicaid, nor are unemployment-based exemptions. The Supplemental Nutrition Assistance Program — often referred to as “food stamps” or “SNAP” — has some work requirements. States can apply for waivers to those work requirements, including if unemployment in a select area is greater than 10 percent. The select area can be a “county, city or Indian reservation.”
Michigan's plan has been approved by the state Senate and is now being taken up by the GOP-controlled House. If passed and signed by the governor, the plan will be submitted to the Trump administration for approval.
Michigan's plan would require “able-bodied” adult Medicaid beneficiaries to work 29 hours or do comparable “work activities” — such as job training or entering a substance abuse program — with exemptions granted to pregnant women, full-time students and some other vulnerable groups.
Medicaid recipients who are granted the unemployment-rate exemption would still be required to report to state officials that they have been looking for a job, said Emily Schwarzkopf of the Michigan League for Public Policy. Those outside the exempt areas would have to comply with the requirement in full.
Snyder initially criticized the bill, with a spokesman telling the Detroit News last month that it was “neither a reasonable nor responsible change to the safety net.” But Snyder spokesman Ari Adler told The Post this week that the governor is working with state Republicans to review details of the legislation.
Critics are urging lawmakers to drop the plan.
“This requirement has been tailored so it targets urban African American Michiganders. We have a responsibility to make sure it does not pass for anybody, but in particular those who are systematically marginalized,” said Abdul El-Sayed, former executive director of the Detroit Health Department and now a Democratic candidate for governor. “It's ridiculous the legislature would even consider something like this.”
Republicans in the state deny the plan was crafted to leave out African Americans who cannot find work.
“The notion that the legislation was written to the benefit or detriment of one group of recipients is false,” Michigan Senate Majority Leader Arlan B. Meekhof (R) said in an email. “The bill is in the early stages of the legislative process and will likely see changes and revisions before it makes its way to the governor.”
State Sen. Mike Shirkey (R), who has spearheaded the plan, did not return a request for comment. His office said Shirkey would not be available to talk and declined to make any member of his staff available to comment or answer questions.
Shirkey previously dismissed the criticism in an interview with the Detroit News. “I don’t know why anybody in Flint would say we need to be treated separate than Genesee County,” Shirkey said. “I mean, is it too much of an expectation to look for jobs if you happen to live in Flint, to look for a job in Genesee County? And the same argument applies to Detroit and Wayne County. How granular do you want to get?”
The plan would save Michigan between $25 million and $45 million annually, despite one-time upfront costs in getting the program running, according to Michigan's nonpartisan House Fiscal Agency.
Correction: An earlier version of this post stated incorrectly that El-Sayed was a challenger to Snyder in the governor's race. Snyder, the two-term governor, is not running.