News India Times

Opinion 3 News India Times February 14, 2020 CanDNATests Tell UsWhoWeAre? Only IfWe'reRacists G rowing up in a homogeneously white Jewish family and going to a homogeneously white Jewish school, I always wondered if there was anything else tomy family's heritage. Some inmy father's swarthy family liked to claimdescent from Spanish Jews who fled the Inquisi- tion to Poland - perhaps there was a reason for my affinity for Mediterranean food! Andmy grandmother liked to talk about her pale mother heralding from Sweden - maybe I had long-lost relatives in charming Stockholm! As DNA tests grewmore popular and affordable, my cu- riosity got the better of me. For about $100, a vial of saliva and a couple weeks of waiting, a company promised a pie chart revealing my ethnic ancestry. The results came back. I was, according to the mono- chrome chart, "100% European Jewish." Looking back, I regret taking the test. Not because it con- firmed the ancestry I could have guessed, nor even for the serious privacy concerns raised by giving my genetic code to a company.What I regret is the ease with which I ac- cepted the racist implications underlying the test: a desire to understand who I am through DNA. In using DNA an- cestry tests, we reduce the culture and lived experience that have long defined ethnicity to a biological, racial signifier that is neither especially relevant nor particularly accurate. By joining in, I inadvertently bought into the dangerous no- tion that who we are lies fundamentally in our blood. There's no putting the genie of DNA testing back in the bottle. But instead of allowing it to cement racialized ways of thinking, we can use these tests to highlight howmean- ingless genetic ancestry is compared with the many other factors that shape our experience of ourselves and our communities. That's exactly what happened in 2018, when Sen. Eliza- bethWarren released a DNA test that indicated distant Na- tive American ancestry. Inmany waysWarren was just using the same flawed, racist logic that I and all other DNA testers followed. Native American leaders rightly pushed back at the time,but the rest of us should, too, when people put undue weight on the findings of these kits. For most of human history, the concept of peoplehood - of belonging to a group larger than one's extended family - has been largely determined by shared cultural practices (such as religion, customs and language) or political insti- tutions. Even when groups have claimed common descent frommythological figures, as Han Chinese do, "blood rela- tions" have remained a smaller and unverifiable compo- nent of peoplehood. This more capacious notion of belonging is how heritage is lived day to day for most people. I didn't need a DNA test to identify as a Jew of European ancestry. I already knew that frommy family andmy culture: frommy religion (Ju- daism), the language of my grandparents (Yiddish), the food I grew up with (noodle kugel, an almost sickly sweet casserole) and the stories of my great-grandparents, fleeing pogroms and learning of the murder of their siblings in the Holocaust. And yet, nomatter how strong it was, this sense of cultural heritage didn't feel like enough for me. In a soci- ety that determines somuch based on blood - money, con- nections, assumptions about character - culture by itself felt like an unreliable narrator of my identity. And I wasn't alone: More than 26 million people are estimated to have taken genealogical DNA tests.Why? The answer goes back to the 18th and 19th centuries, when European colonialism and the slave trade birthed the modern concept of race. As societies were built and genocides committed on the basis of racial hierarchy, it became imperative for racists to prove the biological existence of race. And so race "science" emerged, seeking to dislodge cultural heritage as the prime difference between groups of people. "Aryan" became syn- onymous with "German," excluding the many Jewish and Slavic speakers of the language. Graduates of southern Africa's missionary academies faced a colonial society that saw them as black first, Christian second. While the days of measuring foreheads and skulls are (largely) behind us, race science got a new lease on life when, in the 1950s, scientists discovered the molecular structure of DNA. By the 1980s DNA testing could reliably prove paternity, and by the late 1990s, the first direct-to- consumer genealogical DNA tests were brought tomarket. Ironically, as academics were reaching the consensus that race is a social construct with no basis in biology - about 94% of human genetic variation occurs within so- called racial groups, with racial difference accounting for only 6% - the popularity of DNA testing was helping under- mine that very idea. According to a study fromDNA tester 23andMe and Northwestern University's Center for the Study of Diversity and Democracy, almost 53% of Ameri- cans think biology at least somewhat determines their racial identity. Unsurprisingly, this faith in biological race is stronger among those who benefit from its supposed exis- tence: Two-thirds of white Americans believe that their racial identity is determined by their DNA, compared with about half of black, Latino and Asian Americans. Only 35% of those surveyed believe that shared history or culture de- termines their racial identity. -S PECIAL TO T HE W ASHINGTON P OST By Aaron Freedman TheTrumpAdministrationUsesAnOldPlaybook In ItsNewAttempt ToGutMedicaid hwarted on the issue in Congress, the Trump ad- ministration announced last Thursday that it was inviting states to endMedicaid as we know it. That's not what President DonaldTrump's health officials said, of course. In a detailed letter, they encouraged states to submit proposals to change the way that a big chunk of Medicaid - the joint federal-state health program for the poor - is paid for. Once accepted, these proposals will afford states "new levels of flexibility" while "providing federal taxpayers with greater budget cer- tainty." But there's nomistaking that the Trump administration is moving to transformMedicaid from an entitlement pro- gram covering all the poor into a selective welfare program funded by fixed and limited block grants - a shift that, over time, could starve the programof funding. As matters stand, states get a fixed number of federal dollars for every dollar they spend onMedicaid. Under tra- ditional Medicaid, for example, the federal government covers somewhere between half and three-quarters of the states' costs. And in the Affordable Care Act, Congress said that it would contribute $9 for every $1 in state spending on people at or near the poverty level who weren't previously covered. The unusually generous 90 percent match rate was meant to shield the states from incurring excessively bur- densome financial obligations on account of Obamacare. Because Medicaid is an entitlement program - if you qualify, you're covered - Medicaid payments grow during recessions and contract when the economy is sound. That's good public policy: Medicaid should be there when people need it most. But its structure exposes both the federal gov- ernment and the states to big financial fluctuations. If the economy sours, an expensive new drug is approved or a pandemic hits, payments inevitably grow. The administration's new proposal would change that. For states that ask for and receive a waiver from the Trump administration, federal expenditures for certain groups - mainly the population receiving coverage through the ACA expansion - would be capped at current levels, subject to adjustments for inflation or for new enrollment. The federal government wouldn't pay a dime for medical expenses over the cap. In exchange, states will gain "flexibility" - meaning the freedom to restrict access to the program. Under the Trump administration's proposal, the flexibility would only affect adults under 65 who aren't disabled. States could ask those people to shoulder more financial costs, limit their access to prescriptionmedications and even adopt restrictive new eligibility rules. States could also sidestep federal regulations designed to guarantee that Medicaid beneficiaries can access medically needed care. As matters stand, those regulations prevent states from cutting their payment rates to the degree that no doctors will see Medicaid patients. Now, however, the Trump administration is telling states they can write their own oversight rules. Under one approach sketched out in the letter, the states will be allowed to keep a portion of the money they save for the federal government, so long as they devote those "shared savings" to programs that have something to do with health - whether the programs help the poor. The let- ter offers, as an example, running a tobacco cessation pro- gramopen to the general public (not just Medicaid enrollees). As a result, the stingier the states are withMedicaid, the more federal money they can channel to other purposes. Pruning the Medicaid rolls will thus yield a financial wind- fall for them. In a striking example of doublespeak, the Trump administration is calling this new programHealthy Adult Opportunity - as if the chance to go without health insurance counts as "opportunity." The agenda here isn't subtle. Republicans see "block granting" Medicaid - turning it into a fixed yearly payment rather than one that automatically rises tomeet needs - as a way to limit the federal government's obligations to the poor. There's a clear parallel to 1990s-era welfare reform. In 1996, President Bill Clinton cut a deal with Republicans to transform cash assistance to the indigent into block grants to states - "to end welfare as we know it," as Clinton fa- mously said. The size of those block grants hasn't budged inmore than two decades. In real terms, they're worth about one- third less than they initially were, even as the U.S. popula- tion has swelled by 60 million. With the erosion of cash assistance, the very poor have been left high and dry. By early 2011, as many as 1.5 million households in the country were living on less than $2 a day, as sociologist Kathryn Edin and professor of public policy Luke Shaefer have documented. "Reformers didn't merely 'replace' welfare," they write. "They killed it." The Trump administration wants to run the same game plan for Medicaid. But it faces a challenge: The American public doesn't dislike Medicaid the way it disliked "welfare" in 1996. A lopsided 74 percent of Americans adults say that they have "very" or "somewhat" favorable opinions toward Medicaid, including 65 percent of Republicans, according to a 2018 poll from the Kaiser Family Foundation. The program's popularity goes some distance to ex- plaining why Republicans couldn't block-grant Medicaid when they moved to repeal and replace Obamacare in 2017, despite controlling both Congress and theWhite House. The public increasingly seems to viewMedicaid not as a stigmatized welfare program, but as a crucial part of a broader social commitment to universal health coverage. -S PECIAL TO T HE W ASHINGTON P OST T Nicholas Bagley Professor of law at the University of Michigan

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