Refusal to close the Medicaid coverage gap recalls a dark era from the South's past

In his recent “must read” book on the history of Jim Crow and how it shaped (and was itself shaped) by a typical town of the deep South (“Hattiesburg: An American City in Black and White,” Harvard University Press), UNC Chapel Hill historian Prof. William Sturkey provides numerous illuminating and, often, maddening details of the harsh realities of the racial apartheid that was conjured up and enforced by the white supremacists who dominated so much of southern society for so long.

There are the horrific stories of the lynchings and other murders carried out by white mobs. There are the stories of African-American residents who fled north when given a chance and of others who, despite the frequent terrors and indignities of Jim Crow, stayed, persevered and built lives for themselves and their families. There are the stories of white business leaders who, despite their commitment to segregation, helped inadvertently usher in change by embracing elements of modern capitalism and interstate commerce. And there are the stories of how the residents of segregated Black communities came to build their own vibrant institutions – many of which ultimately helped give rise to the Civil Rights Movement of the mid-20th Century.

About a third of the way through the book, however, Sturkey relates a truly remarkable and tragically telling anecdote from the Great Depression that rings eerily familiar in 2019.

It seems that in 1931 – a time in which, of course, people of all races were suffering mightily – the national Red Cross provided a grant to the local branch for emergency aid to people in need. The grant specified that it was to be used for the purpose of distributing goods to poor families “without food, clothing and fuel.” The Red Cross’s Mississippi field representative pledged that “no hungry person will go unfed” and that “no family needing food, clothing, medical supplies or fuel will go unattended in Forrest County.” (Hattiesburg is located in Forrest County, which is named after the notorious slave trader, Confederate general and, later, KKK founder, Nathan Bedford Forrest).

While the relief effort got off to a promising start with the Red Cross providing aid to some 500 families, there soon arose a problem that the reader can likely guess at: the city’s white power structure found itself at odds with the Red Cross over the fact that the charity was, pursuant to national policy, serving families of all races. Among other complaints, the United Daughters of the Confederacy protested to the Mayor’s office that the group’s members found it “embarrassing” to see “droves of Negro applicants” in City Hall.

Soon thereafter, the city’s mayor issued an ultimatum to the Red Cross in which he demanded that the organization either cease serving Black residents or vacate City Hall. When the Red Cross refused, the city evicted the group.

It’s almost impossible when reading such a story not be struck by the parallels to the 21st Century. Today, across most of the old Confederacy, political leaders turn down all manner of federal safety net assistance – most notably, expansion of the Medicaid program to close the massive health insurance gap that has entrapped millions – because many of the people who would be helped are, in the eyes of the conservative political power structure, “unworthy.”

If there were ever any doubts about this latter dark truth, North Carolina Senate President Pro Tem Phil Berger dispelled them recently when he stated his belief that Medicaid expansion “disincentivizes folks to go to work.” In other words, Berger is against expanding Medicaid because he believes that some of those who would benefit do not (or would not) work hard enough to suit him and are therefore unworthy of the assistance.

None of this is to imply that Berger’s stance is founded in racism. While it is striking that so much of the resistance to Medicaid expansion remains headquartered in the South and is led by an almost exclusively white political party – a party that has worked to suppress the voting power of African-Americans and to preserve Confederate monuments – one can take the movement leaders at their (frequently uttered) word that their motives are ideological in origin, rather than racial, and still see obvious parallels to the past.

This is because, when distilled to their essence, the policies of the city of Hattiesburg, Mississippi of 1931 and the state of North Carolina 88 years later differ little in substance. Both are based on the premise that it’s better that “worthy” human beings suffer and even die prematurely on a large scale than it is for disfavored, “unworthy” humans (whatever their race) to receive basic, lifesaving assistance.

Sturkey reports that, at the time, the Philadelphia Tribune decried the Hattiesburg incident by observing that “Even the gnawing pains of hunger are unable to make the white people of that God-forsaken section forget their white supremacy.”

Today, quite similarly, it’s clear that even the gnawing pain emanating from thousands of premature deaths is unable to make many of the already insured people of North Carolina forget their presumptions of moral supremacy.