A man walks beneath an American flag at the Owsley County Saddle Club trail ride on April 20, 2012, in Booneville, Ky. The trail ride attracts riders from outside the county who contribute much-needed revenue. The 2010 U.S. census listed Owsley County as having the lowest median household income in the country outside of Puerto Rico, with 41.5 percent of residents living below the poverty line.
Photo: Mario Tama (Getty Images)

Let’s talk about institutional racism, shall we?

For those who don’t know (and at this point, there’s really no reason not to), institutional racism occurs when discrimination is perpetuated by the state or government, versus the actions of individuals, and given its outsize influence is wont to perpetuate more insidious and long-lasting damage on marginalized communities. Redlining as supported by the federal government, segregation in the Army, and de jure segregation in public schools are but a few examples of how institutions have upheld white supremacy.

But if you thought that such practices stopped long ago, Donald Trump is here to tell you that he’s about to make America great again by getting people off welfare. But there’s a caveat, of course.

We all know that the Trump administration has aggressively pushed for those who receive “welfare,” or any type of subsidy from the government, to meet mandatory work requirements; in effect, a tax on the poor. But even in this, certain states have found a way to exclude those who live in rural, almost exclusively white, heavily Republican-leaning areas.

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As Talking Points Memo reports:

In the GOP-controlled states of Kentucky, Michigan and Ohio, waiver proposals would subject hundreds of thousands of Medicaid enrollees to work requirements, threatening to cut off their health insurance if they can’t meet an hours-per-week threshold.

Those waivers include exemptions for the counties with the highest unemployment, which tend to be majority-white, GOP-leaning, and rural. But many low-income people of color who live in high-unemployment urban centers would not qualify, because the wealthier suburbs surrounding those cities pull the overall county unemployment rate below the threshold.

[H]ealth-law experts say the waivers—already approved for Kentucky, pending for Ohio, and advancing in Michigan’s Legislature—may run afoul of Title 6 of [the] Civil Rights Act of 1964, which prohibits race-based discrimination in federal assistance programs. Under that statute, even policies that are racially neutral on their face but have a disparate impact on a particular group could be illegal.

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For example, in the state of Kentucky, work requirements will be imposed first in northern Kentucky, which includes counties with a higher concentration of black residents, but the waiver will effectively preclude eight southeastern counties, where the percentage of white residents is more than 90 percent. But of course it would. There’s that making-America-great-again rhetoric.

In Michigan, it has been estimated that about 15 percent, or 105,000 people, could lose their insurance because of these new mandates, but people who live in counties with unemployment rates above 8.5 percent would be exempt (think white, rural, Republican), while those poor people in Detroit and Flint would bear most of the burden.

Over in Ohio, which recently submitted its work requirements for federal approval, the report says that the effects of the new rules will be similar to those in Michigan; that is, mostly black, urban residents of color in the Ohio cities of Cleveland and Columbus will bear most of the burden of the new rules, while whites in rural areas will not.

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“The communities most at risk under this scenario are African American, and those communities already have significantly higher rates of infant mortality, lower life expectancy, and a number of other serious health disparities,” John Corlett, Ohio’s former Medicaid director and the president of Cleveland’s Center for Community Solutions, told TPM.

He continued, “Our housing patterns in Ohio are influenced by a past history of institutionalized segregation, and the Medicaid waiver reinforces that instead of mitigating it. Ohio could help mitigate the racially discriminatory impact of the waiver by exempting smaller units of government—like municipalities.”

The good news is, like all misguided and usually racist Trumpian policies, there may be injunctive relief in the courts.

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The Kentucky mandate has already been challenged in federal court in a class action suit of 15 Kentuckians who are being represented by the Southern Poverty Law Center.

That lawsuit predicts that at least 100,000 Kentuckians will lose Medicaid if the state’s plan moves forward.

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We can assume that most would be people of color.