Health Affairs This Week BEST OF: Power and Its Impact on Medicaid w/ Jamila Michener
Jan 7, 2026
Jamila Michener, a political scientist at Cornell University and author of 'Fragmented Democracy', dives into the complexities of Medicaid and political power. She discusses how the design of Medicaid limits beneficiaries' influence and emphasizes the importance of framing power in policy discussions. Michener also explores how organized interests shape Medicaid's growth and advocates for empowering beneficiaries in decision-making. Lastly, she highlights obstacles to change but notes a positive momentum towards shifting power.
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Power Defined As Capacity To Change Life
- Power is the capacity to use political tools to change the circumstances shaping your life and community.
- If political actions repeatedly fail to change outcomes, individuals lack power.
Medicaid Is Built On Political Contestation
- Medicaid requires substantial public resources and therefore is shaped by political contestation and power struggles.
- Who holds power determines how redistributive resources like Medicaid are allocated.
Avoiding Power Talk Can Backfire
- People often avoid framing Medicaid as about power because they fear partisan polarization will harm the program.
- Avoiding the topic doesn't stop power from operating; it merely leaves it unexamined and unchecked.
