Medicaid provides health care for around 1 in 5 Americans. Despite the large number served, the programs administration by state and local governments means very different things in different places. The geography of federalism matters a lot for Medicaid. But unlike some other large social welfare programs, Medicaid seems to reduce rather than increase political participation, resulting in a population of people stigmatized by the program itself and afforded less political representation.Such is a snippet of the argument made by Jamila Michener in her fascinating new book, Fragmented Democracy: Medicaid, Federalism, and Unequal Politics (Cambridge University Press, 2018). Michener is assistant professor of political science at Cornell University.Through extensive quantitative and qualitative research, Michener spotlights the people of Medicaid, their awareness of the inequalities that exist across states and localities, and how some are mobilizing to better represent the Medicaid community. What she finds is that where you reside determines a lot about your relationship to the Medicaid program, from state to state and even from neighborhood to neighborhood in a given city.