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  • Cited by 187
Cambridge University Press
Online publication date:
March 2018
Print publication year:
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Book description

Medicaid is the single largest public health insurer in the United States, covering upwards of 70 million Americans. Crucially, Medicaid is also an intergovernmental program that yokes poverty to federalism: the federal government determines its broad contours, while states have tremendous discretion over how Medicaid is designed and implemented. Where some locales are generous and open handed, others are tight-fisted and punitive. In Fragmented Democracy, Jamila Michener demonstrates the consequences of such disparities for democratic citizenship. Unpacking how federalism transforms Medicaid beneficiaries' interpretations of government and structures their participation in politics, the book examines American democracy from the vantage point(s) of those who are living in or near poverty, (disproportionately) Black or Latino, and reliant on a federated government for vital resources.


Winner, 2019 Virginia Gray Best Book Award, American Political Science Association State Politics and Policy Section


‘I have not read a book in a better part of a decade where I learned as much or where my ideas of American federalism were so usefully challenged. With incredibly keen insight and breathtaking analysis, Jamila Michener unearths the dire ramifications of how people-based policies intersect with place-based inequalities. Federalism may feed liberty but it also undermines equality, one of our nation's most cherished ideals. … Fragmented Democracy will revive debates about democracy in America, federalism and its consequences, racialized poverty and political inequality, and the importance of place in political life. The message takes on urgent importance in our time, pushing us to reimagine the policy at the local, state, and national levels. … An extraordinary achievement.'

Vesla Mae Weave - Michael Bloomberg Distinguished Professor of Political Science and Sociology, The Johns Hopkins University

‘This blockbuster book uses a rich, multi-method approach to examine the profound implications of federalism for American democracy. Due to the heterogeneity arising from giving policy responsibilities to state and local governments, the poor face extraordinarily varying levels of policy responsiveness and political incorporation, based on the lottery of where they happen to live. Everyone interested in poverty, inequality, and citizen participation should read this deeply creative and thought-provoking analysis.'

Andrea Louise Campbell - Massachusetts Institute of Technology

‘Jamila Michener has given scholars and citizens a great gift. Fragmented Democracy is a tour de force of empirical political analysis that doubles as an unusually humane and incisive meditation on the troubled state of American citizenship. … Fragmented Democracy is a powerful work of critical, empirically grounded political analysis. It deserves to be widely read and discussed.'

Joe Soss - Cowles Professor for the Study of Public Service, University of Minnesota

‘Jamila Michener has written a powerful, engaging and urgent book that shows, with devastating clarity, the effects of our federal system on the political equality of tens of millions of Americans, particularly the poor and African-Americans.'

Lisa L. Miller - Rutgers University, New Jersey

‘The book … contributes to our understanding of minority politics and racial inequality in the American context, as Medicaid disproportionally serves people of color who live in or near poverty. At the micro-level, the author does an exceptional job putting a face to those who experience the injustices of the Medicaid system.’

Mariely Lopez-Santana Source: Publius: The Journal of Federalism

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