The Politically Charged History of the Term ‘Able-Bodied’

Congressional Republicans would have us believe that the so-called “able-bodied” are everywhere among government anti-poverty programs, taking away assistance from those who are more “deserving.” But far from describing a defined demographic group, there is no standard definition that makes a person “able-bodied.” Rather, the term has long been ingrained with political and moral implications.

As Emily Badger and Margot Sanger-Katz write in The New York Times’ Upshot, “Across centuries of use, [the term] has consistently implied another negative: The able-bodied could work, but are not working (or working hard enough). And, as such, they don’t deserve our aid.”

I spoke with Badger to unpack the 400-year history of the term able-bodied.

Rebecca Vallas: Emily, I have to admit I nerded out hard reading this piece—a 400-year history of the term that is centrally housed in every debate around the deserving versus the undeserving poor, something we’re very much living through in this political moment—just how very cool that you did this. Help tell that story, where does it go back to 400 years ago?

Emily Badger: The genesis for this piece is that my colleague Margot and I realized that we had this mutual suspicion of the term “able-bodied.” People constantly use it in conversation with us in Washington and in policy circles and the think tank world. But we both felt like we shouldn’t use this term ourselves as journalists, at least not without quotation marks around it, because it’s loaded, it carries a lot of connotations that people don’t explicitly express. And in Washington, it’s quite common that we fight about politics through rhetoric.

So Margot and I asked, what is the story behind the term? Where did it come from? How have we come to use it? What do people really mean when they use it?

We started reaching out to historians, and other people who are familiar with the backstory of the Medicaid program. Over and over again people told us that we need to learn about English poor law dating to 1601. It turns out that this set of laws—which are really the foundation of social policy in the United States—included the phrase “able-bodied.” They include from the very beginning this distinction between the impotent poor, meaning people who are powerless to help themselves, and the able-bodied poor. And the idea that we should provide resources and aid to the impotent poor but we shouldn’t freely give stuff away to the “able-bodied”—maybe what we should do is set them up at workhouses, try to connect them to work opportunities. But very early on there was this distinction between people who we thought should be working, and people who couldn’t work for a reason.

RV: The first distinction between the deserving and the undeserving.

EB: Exactly, and the idea that some people are worthy and some people are not gets expressed now in a lot of different ways. We talk about people who are lazy versus people who are industrious, or people who are able-bodied versus people who are crippled or disabled. Whatever language we use, there’s always this idea that one group unquestionably should be given help without judgment and the other group is probably trying to freeload off of the public. As one historian pointed out to me, that’s part of the reason we have these really expensive government bureaucracies in the United States around anti-poverty programs—we construct these elaborate bureaucracies to try to separate these two groups of people.

We construct these elaborate bureaucracies to try to separate these two groups of people

When we require people to qualify or submit new paperwork multiple times a year, or when we’re talking about work requirements, or when we require people to show that they’re in a job training program or that they’re actively looking for work even if they don’t have work available … all of that is part of this expensive process of trying to identify who is deserving and who is not.

RV: And one of the points that your piece makes is that “able-bodied” isn’t just an inherently political term—it’s also a heavily moral term, and that’s a large part of why politicians and elected officials are using it.

EB: Yeah, one of the historians put it really perfectly—he said that the physical distinction always implies a moral distinction. And even though this dates back to Elizabethan England, this idea is very American, too: that work is moral, if you are a good person you are working hard. If you are not working hard, that’s a result of some kind of moral failing on your part. That’s a very old puritanical idea but obviously it’s one that carries through to debates that we’re having in 2018 about programs like Medicaid.

RV: Today we’re familiar with the vast and expensive government bureaucracies you were describing that create hurdles for getting assistance—how did it work back in the 17th century?

EB: So the 1601 poor law in England codified what a lot of communities were already doing. It basically said we’re going to collect taxes from people and then redistribute them to support and help the poor. It placed the onus on people in individual communities, like parish wardens and overseers of the poor, to be responsible for collecting and redistributing that money. So there were people living in the community who knew, for instance, that David over here has tuberculosis and he can’t support his family and he’s got 8 children and they’re all dependent on him and obviously the mother can’t work because she’s also trying to take care of the children. It’s quite clear to the parish warden that David and his family are worthy.

Translating this idea over the years, we’ve erected these larger and more centralized government programs. Someone who is sitting in a Medicaid office in Kentucky doesn’t personally know you and your story to be able to say if they think you are clearly worthy or not. So these same distinctions are made through these other very complex processes: Can you show us a doctor’s note that explains why you aren’t capable of meeting a work requirement that we’ve imposed on you? Or some other qualification criteria. Essentially these bureaucracies are trying to do what the parish warden was trying to do 400 years ago.

RV: I was fascinated to read in your piece that apparently at some point the English came to recognize not just the able-bodied versus those who were not able-bodied, but a third group of people: the able-bodied who were blocked from work for reasons that weren’t about their bodies.

EB: Yeah, I think once you start separating the poor into two groups of people and make these distinctions, it will become clear that there are people out there who appear to be physically capable of work but they’re not working, and it doesn’t seem like they’re lazy, so there must be other things that are preventing them from working. Maybe the economy is really bad, or there aren’t enough jobs in the local community. Maybe this person isn’t very mobile and so they can’t travel to where the jobs exist.

If you deploy any thoughtfulness you recognize that there are plenty of people who don’t work for reasons that don’t have to do with their body. There are barriers to employment that are in the community, in the structure of the economy, embedded in discrimination in the labor market. And this process of setting everyone who is poor into one of these two categories becomes murkier once you realize that the world is more complicated than that.

But what was so striking to us about this history is that the language they were using to debate this, 300, 400 years ago, is identical to how we talk about the poor today. Not only are we still talking about the able-bodied and the deserving, but we’re still having arguments today about why aren’t “able-bodied” people working? Is it their own fault or is it because there are structural obstacles? And just as was the case 300 years ago, I think today we often have a hard time distinguishing between personal failings and structural obstacles. People still wind up frequently conflating structural issues with some kind of moral deficiency on the part of people, which is fundamentally unfair.

RV: One of the bureaucratic hurdles that has been set up over the years to make it harder for struggling folks to access basic assistance is drug tests. I was fascinated to learn from your reporting that modern-day drug tests actually have origins in the 18th century.

EB: Yeah, this is one of the particular moments in reporting this where everything came together for me and I realized how much we are having the same conversation today that we were having 400 years ago. One of the historians, Susannah Ottaway, told me that back in Elizabethan England, they started to set up these rules to try to distinguish who is worthy, and who is not. Things like, if anyone in the community has seen you getting drunk in the local alehouse we know that you are not worthy.

RV: Here was the rule, quote: “Nobody who tipples in the alehouse will get poor relief.” That was the 18th century drug test, right?

EB: Exactly. So if you can’t figure how to distinguish who is worthy from who is not then you set up rules that effectively force the poor to reveal themselves. This rule was about people who are drunk. Today we would set up a rule about drug-testing which is basically a hoop that we make the poor go through in order to reveal themselves as being someone who we ought give assistance to. And this is so similar to what you often hear in Washington today, when we talk about creating more onerous eligibility criteria. If you really need aid, you’re going to be willing to come in to the local bureaucratic office and fill out new paperwork every month, or you’re going to be more than happy to take this job training program as a condition of receiving aid, because if you really need it you will do anything to get it. And that’s the exact same idea that you could reveal yourself to be someone who desperately wants this by your willingness to overcome all the obstacles we’re putting between you and the aid.

And of course it ignores the fact that people may have a difficult time meeting all of those requirements for reasons that have absolutely nothing to do with their willingness or their desire. Maybe you don’t have a car and it’s not practical for you to get to this meeting every month, maybe your housing situation is really unstable and you don’t receive bureaucratic mailings that are sent to you twice a year reminding you to sign up for things.

We’re now moving backwards. We’re rolling back that long-term story of expanding to more and more people

RV: Now the Medicaid program itself is actually in many ways a historical tracker of the evolution of this kind of thinking. Medicaid began in 1965, with, as you put it, “Elizabethan notions in tact,” but over time has evolved to something that looks very different. Tell us a little bit of that story of the evolution of Medicaid.

EB: The Medicaid program originally recognized these very familiar classes of the “deserving” poor. If you are a pregnant woman, if you are blind, if you are physically disabled, these are classic categories that everyone has agreed to going back a long time, these are people who are worthy of help. And over time the Medicaid program has extended help to people beyond those core groups that would be familiar even in Elizabethan times. It’s extended to women who had certain kinds of cervical or breast cancer, it was extended to more parents, it basically became more expansive and more generous over time. And that kind of culminates in the Affordable Care Act when we’re finally saying it doesn’t matter if you’re a parent, if you have dependents, if you have some kind of physical condition that prevents you from working, whatever you are, if you make below a certain income, you qualify. We’re going to get rid of all of these other distinctions about who qualifies and who doesn’t and set an income cut-off.

That’s what the Affordable Care Act tried to do with the Medicaid expansion, which ultimately a lot of states declined to participate in. But that story, that evolution, marks a kind of progress from this history that we’ve been talking about. But what’s so notable about these new work requirements that are coming through Medicaid waivers from the Trump administration is that we’re now moving backwards. We’re rolling back that long-term story of expanding to more and more people. I think the term able-bodied has particularly come into fashion in the last five years or so because it has been used specifically to refer to the Medicaid expansion population.

But conservatives in particular who are concerned about all of the “able-bodied” are saying wait a minute let’s scale it back, let’s go back to trying to make some distinctions between who is able-bodied and who is not. But of course as we were talking about before, once you start saying that you want to make these distinctions between the deserving and the undeserving, then you realize wait, we have to carve out an exception for these people and for these people and for these people, and that exercise of carving out all these exceptions reveals the underlying folly of trying to make these distinctions in the first place.

RV: So given this history lesson, what’s your takeaway in terms of what we are seeing today?

EB: The main thing that Margot and I really wanted to get across in writing about this is that this is not a neutral term. It doesn’t have a technical definition. It’s being used in a slippery way to imply lots of unspoken things. And so just stop and take pause when you hear it. I think Margot and I are sort of secretly hoping that other journalists will realize that they should not just repeat this language when it comes out of politicians’ mouths. I would stick it in quotes if I had to use it in a story. We’re always going to fight about our politics through rhetoric in Washington. That’s not going to change. But at the very least let’s all be honest about what’s happening with this term.

This interview was conducted for Off-Kilter and aired as part of a complete episode on February 9. It was edited for length and clarity.



Congress Is Voting on a Bill That Could Make Debt Traps Legal Again

Today, the House of Representatives votes on an end run around state consumer protection laws. If it passes, the bill would overturn state efforts to stop payday lenders from charging triple-digit annual interest rates and creating consumer debt traps that can turn a $1,000 loan into a $40,000 debt.

The bill—misleadingly titled “Protecting Consumers’ Access to Credit Act of 2017”—claims to be a response to a recent federal court decision in a case called Madden v. Midland. Ms. Madden opened a credit card; when she fell behind on payments, it was sold to Midland Funding, a debt collector. Midland tried to charge her an interest rate of 27 percent, higher than New York’s legal limit of 25 percent, and the judge ruled that while banks are not subject to state interest rate caps—consistent with rulings going back several decades that led to the rapid growth of credit cards—nonbanks, such as a debt collector, are. The decision was reached by the Second Circuit, and only applies to New York, Connecticut, and Vermont.

In the bill, both houses of Congress have proposed a so-called “Madden fix” that would declare that any valid loan made by a bank stays valid if that loan is later sold or transferred to a nonbank. On its face, that sounds fair—until it’s clear that this is exactly the business model, sometimes called rent-a-bank, that payday lenders have historically used to get around state consumer protection laws. Under rent-a-bank, in a state that caps annual interest rates at 36 percent or less—a level considered the maximum for responsible lending for about a century—a loan shark shut out of the market can just partner with a national bank that’s subject to no limits on interest rates at all, and charge consumers more than 300 percent annual interest or more. This practice goes back two decades, and federal banking regulators have been grappling with it just as long.

Under rent-a-bank, a loan shark can just partner with a national bank and charge consumers more than 300 percent annual interest

Getting around state laws also means skirting the will of Americans that have elected to keep predatory lenders out of their states. Fifteen states and the District of Columbia—representing more than 90 million Americans—have set interest rate caps to keep payday lenders at bay. South Dakota joined this club in 2016 with a ballot initiative receiving more than 76 percent of the vote, despite confusing, contradictory language on the ballots. Seventy-two percent of Montanans voted for a cap in 2010. And faith leaders across the country have decried the practice—some even using their own community assistance funds to bail out borrowers trapped in debt.

Even in states where payday lending is not restricted with a rate cap, forty-two states have interest rate caps in place for some other types of loans, such as installment loans, which are generally paid back over a longer period of time. It’s no surprise that the Consumer Financial Protection Bureau’s (CFPB) 2017 payday lending rule specifically called out rate caps as providing better protections than what it could do itself to deal with debt trap lending. (The Dodd-Frank Act, which created the CFPB, specifically bans the agency from capping rates itself.)

Taking away states’ ability to pass and enforce laws that protect their residents from loansharking might not be so devastating if a tough federal standard existed in their place. But this January, CFPB Acting Director Mick Mulvaney delayed the final payday rule, which only dealt with certain aspects of predatory lending, with an eye toward weakening or scrapping it altogether. New Trump-appointed leadership at the banking regulators are not likely to scrutinize rent-a-bank partnerships the way past regulators have, and the Office of the Comptroller of the Currency, one of these regulators, reversed its restrictions on banks themselves making payday loans last year. The closest Congress has come to taking decisive action to help vulnerable borrowers in recent years was passing the bipartisan Military Lending Act in 2007, which put in place a 36 percent rate cap on servicemembers and their families—and still only survived an effort to weaken it in 2015 by one House committee vote.

To be sure, some nonbank lenders who do not make payday loans have argued that the Madden decision makes it harder for even responsible startups to lend nationwide because investors will not support them if loans may be invalidated under state law. But they have other options, including seeking a federal nonbank charter or simply ensuring that they comply with state law. Supporting a nationwide market should not mean forcing open the doors to financial exploitation by allowing lending without limits.

Should the House bill pass this week, it then goes to the Senate, where a bipartisan group of senators has teamed up to co-sponsor the same bill. In an era of massive tax cuts for the rich and devastating benefit cuts for everyone else, this is merely the latest attempt from Congress to tilt the financial playing field further in favor of corporations and the wealthy, making it even harder for working families to get by.



See the March That Revived Martin Luther King Jr.’s Poor People’s Campaign

In Memphis yesterday, the Fight for $15 and the new Poor People’s Campaign joined forces to mark the 50th anniversary of the sanitation workers’ strike and march with Dr. Martin Luther King Jr.

Workers came from as far as St. Louis, Chicago, New Orleans, and Boston, as hundreds of people walked the same path to City Hall as their predecessors once did, and issued the same demand: a living wage and the right to form a union.  Workers and activists will continue the campaign in the coming months, with six weeks of direct action and nonviolent civil disobedience beginning on Mother’s Day.

Photographer Andrea Morales was on hand to capture how the day transpired.

Hundreds walk down Dr. Martin Luther King Jr. Avenue during the march from Clayborn Temple to Memphis City Hall to commemorate the 50th anniversary of the 1968 sanitation workers' strike.
Hundreds walk down Dr. Martin Luther King Jr. Avenue during the march from Clayborn Temple to Memphis City Hall to commemorate the 50th anniversary of the 1968 sanitation workers’ strike.
AFSCME Secretary Treasurer Bill Lucy (center), stands between Baxter Leach, one of the sanitation workers who went on strike in 1968 (left), and Rep. Steve Cohen (right) at Clayborn Temple, where marchers gathered.
AFSCME Secretary Treasurer Bill Lucy (center), stands between Baxter Leach, one of the sanitation workers who went on strike in 1968 (left), and Rep. Steve Cohen (right) at Clayborn Temple, where marchers gathered.
Fight For $15 supporters lead chants before the march begins.
Fight For $15 supporters lead chants before the march begins.
Marquisha McKinley and her daughter in the Fight for $15 strike line outside a McDonald's in Midtown Memphis.
Marquisha McKinley and her daughter in the Fight for $15 strike line outside a McDonald’s in Midtown Memphis.
Fists are raised as a moment of silence is called before the march reaches its destination at Memphis City Hall.
Fists are raised as a moment of silence is called before the march reaches its destination at Memphis City Hall.
A couple that traveled with Fight for $15 from St. Louis listens to speakers during the program at Memphis City Hall.
A couple that traveled with Fight for $15 from St. Louis listens to speakers during the program at Memphis City Hall.
A young marcher catches some rest. Many workers and supporters brought their children along to the event.
A young marcher catches some rest. Many workers and supporters brought their children along to the event.
Baxter Leach, a former sanitation worker who was part of the original strike in 1968, is embraced by SEIU President Mary Kay Henry during a program following the march.
Baxter Leach, a former sanitation worker who was part of the original strike in 1968, is embraced by SEIU President Mary Kay Henry during a program following the march.
Rev. Traci Blackmon, a United Church of Christ pastor based in Florissant, Missouri, speaks at City Hall to close out the march. She recalled the workers' deaths that sparked the original strike 50 years ago: "I don't want to stand here and forget Brother Cole and Brother Walker, who died in a garbage truck, crushed to death because the government refused to fix the garbage trucks."
Rev. Traci Blackmon, a United Church of Christ pastor based in Florissant, Missouri, speaks at City Hall to close out the march. She recalled the workers’ deaths that sparked the original strike 50 years ago: “I don’t want to stand here and forget Brother Cole and Brother Walker, who died in a garbage truck, crushed to death because the government refused to fix the garbage trucks.”



Yes, Replacing Food Stamps With a Blue Apron-Style Delivery System Is As Bad As It Sounds

Yesterday, the Trump administration released its fiscal year 2019 budget. For the most part, it’s similar to last year’s proposal: massive cuts to safety net programs, a big boost in military spending, and very Trump-ed up estimates of economic growth. But this year, tucked into the Department of Agriculture (USDA) subsection, the administration laid out a proposal to take away a chunk of the nutrition assistance many families rely on and replace it with a massive new food delivery program.

Under the proposal, households receiving $90 or more per month in Supplemental Nutrition Assistance Program (SNAP) benefits—which accounts for the vast majority of all of the households who currently participate in SNAP—will receive a portion of their assistance in the form of a box of pre-selected food. According to the USDA, which would be responsible for administering the program, the box would be filled with items like pastas, peanut butter, beans, and canned fruit, intended to “improve the nutritional value of the benefit provided and reduce the potential for EBT fraud.”

In effect, the proposal is a paternalistic spin on Blue Apron: Instead of being able to choose food based on their nutritional and family needs, SNAP households may get standardized boxes of food that the government chooses on their behalf. Hunger and nutrition experts have panned this as “costly, inefficient, stigmatizing, and prone to failure.” A 2016 USDA study found no evidence to suggest that households who receive food stamps need the government to select their food for them—their spending habits are almost identical to other households. (The only exception is baby food—SNAP households buy a lot more of it, because they’re twice as likely to have a child under age 3.) Replacing the food that people are buying for themselves with pastas and canned fruit is likely a nutritional downgrade. And, since the food is being delivered directly to families, it’s unclear whether families will get the opportunity to provide input based on allergies or specific nutritional needs—say, to account for a peanut allergy, or for all that baby food.

As for reducing EBT fraud, the Trump Administration is offering a complicated solution for a nonexistent problem: SNAP fraud is extremely rare, and the government spends about as much money looking for SNAP fraud as it actually finds in misused funds. (As a point of comparison, the Pentagon misplaces enough money every year to fund the entire SNAP program twice.)

The government spends as much money looking for SNAP fraud as it actually finds in misused funds

What’s more likely is that the proposal will become a giveaway to major agriculture companies. Creating this type of program will require a massive number of new government contracts for food, shipping, storage, and delivery. These contracts will have volume requirements that smaller farms will not be able to meet, but they’ll open the door wide to America’s “Big Aglobbyistsincluding those with close ties to Trump’s Secretary of Agriculture Sonny Perdue.

And given that this proposal is paired with a $214 billion cut over the coming decade—nearly one-third of total SNAP spending—as well as punishing time limits for workers who cannot find a job or get enough hours at work, it’s hard to believe this proposal is anything but malicious.

Considering Trump’s past statements on food stamps—and on poverty in general—it’s likely that malice actually is at the core of this. Remember the time that he said the only reason a protestor could be angry that he was talking about food stamps was because the protestor was fat? Or the time he said he “just doesn’t want a poor person” involved in decisions about the economy? The president sees his own wealth as the chief validator of his societal worth, and believes it makes him perfectly qualified to make choices about how low-income people live their lives. This SNAP proposal is the result of that line of thinking. It strips people of control over one of their most basic decisions—what they’re going to eat—and hands it over to a government agency. It flattens out the shades of humanity that go into our food—the garlic or chilis or cumin or fish sauce we use when we need to make dinner feel more like home, or the choice to splurge on a steak for your wife’s birthday dinner even if it means you’ll be scraping by for the rest of the month—and it replaces them with cans of fruit in a cardboard box.



How Trump’s Medicaid Restrictions Will Stop People From Voting

The Trump administration released its fiscal year 2019 budget today, and it doubles down on what the administration has already been doing to undermine Medicaid—including more than $300 billion in cuts to the program and a call to take health insurance from those who can’t find a job.

Last month, the administration began testing these policies at the state level. On January 11th, the Centers for Medicaid and Medicare Services (CMS) announced that states can now compel low-income people who rely on Medicaid to meet “work and community engagement requirements” in order to keep their health insurance. Within a day of making this announcement, CMS approved Kentucky’s plan to implement such requirements. The plan strips Medicaid coverage from most adults who fail to comply, including those who do not complete paperwork on time or report “changes in circumstances” quickly enough.

All told, Gov. Matt Bevin’s office estimates that around 350,000 Kentucky residents will be subject to the new requirements and 95,000 will likely lose their Medicaid benefits. But once those people are booted from the program, Kentucky is giving them a chance to get it back: through “a financial or health literacy course.”

Of course, this is not the first time that Americans have been required to meet economic standards or pass a literacy test to exercise their rights. Discriminatorily applied literacy tests, known for their impossible difficulty, were administered by election officials who were given immense discretion over who to test, what to ask, and how to assess the answers when (mostly black) citizens attempted to vote. Similarly, extractive poll taxes disenfranchised poor black populations (and sometimes poor whites) from the end of the 19th century until the advent of the 24th Amendment (1964) and the Voting Rights Act (1965).

95,000 Kentucky residents will likely lose their Medicaid benefits

These methods were incredibly effective at preventing black people from voting. They led to dramatic drops in black voter registration in the South, and in the states that were the most egregious offenders—like Louisiana—black voter registration decreased by as much as 96 percent over an eight-year span.

Of course, the electoral arm of white supremacy in the postbellum era stretched well beyond such tools (and all the way to violent repression). Nevertheless, taxes and tests stand out as especially contemptible because they officially codified a logic of exclusion aimed at those presumed unworthy of American citizenship.

On the surface, Kentucky’s new Medicaid rules don’t look exactly like poll taxes or literacy tests. But there’s an equivalent logic of exclusion that holds across both domains: Those who are unworthy—either because of their race or due to their inability to access decent jobs—are ousted. Their political and social rights (like the right to vote and the right to be healthy) are sacrificed on an altar built by those with power.

Since social rights like health care are connected to political rights like voting, undermining one deteriorates the other. When Medicaid recipients are made to jump through hoops to prove that they are worthy of health care, they quickly figure out where they stand in the American social hierarchy. And once that’s clear, they have a diminished desire to participate in politics.

I know this because I spent years studying Medicaid and wrote a book about the politics surrounding it. I had in-depth conversations with people who use Medicaid; I observed  Facebook groups filled with Medicaid beneficiaries who readily recounted their experiences; I examined thousands of responses to large national surveys; and I scoured administrative records that detailed the actions that people with Medicaid took when they had scuffles with the government. I got to know some of the people who will find themselves at the losing end of the new Medicaid regulations, and I discovered how Medicaid shapes their political choices.

Take Angie, for example. Michigan’s Medicaid program stripped her coverage for not completing paperwork that she never even received. After battling for several months with local bureaucrats, she finally got her benefits restored. But by then she knew who she was in the eyes of the government:

“It’s like you are uneducated and you just want to get these free services and somehow you are inferior to other people if you receive those benefits … Once they hear Medicaid its ‘oh, one of those people.’”

Alienated from the government, Angie stopped voting and trying to advocate for herself. “I don’t do politics,” she said. When we talked about why she wouldn’t appeal devastating benefit cuts, she explained that she was a “nobody” and that the “powers that be” would not bend very far for her.

Angie was hardly alone. Ahmad fought back tears when he told me about the bureaucratic hurdles he faced after losing a limb in Iraq. Again and again he had to re-certify his enrollment, refile paperwork and find new medication when the old ones were no longer covered by Medicaid. He was clear on what this implied about his social status. “They treat us like we are stupid animals; like we don’t know anything,” he says. “I feel like I’m nothing, because when you are in Medicaid, they do whatever. You have to be on their rules.”

Just as literacy tests were applied unfairly by the election officials who administered them, adding stipulations to Medicaid will create opportunities for racial inequity. Blacks and Latinos face more labor market discrimination, have a harder time finding quality child care, and—because of biases in the justice system— are more likely to have a criminal record. In the face of such barriers, work and health literacy requirements pose burdens that will fall disproportionately on people of color.

That brings us back to where we started. Both types of literacy testing are predicated on assumptions about who deserves access to fundamental social and political rights, like health care and voting. Both also reinforce racial and economic inequality, whether purposely or inadvertently. Most crucially, both lead to the erosion of democratic citizenship among Americans whose political power has long been systematically suppressed.