The city of Texarcana literally sits on the border between Texas and Arkansas, partly in one state and partly in the other. That means that some of its residents may be eligible for a health insurance subsidy under Arkansas’ Medicaid expansion/privatization hybrid. Or they may be in Texas and be screwed like anyone else.
Arkansas accepted the Medicaid expansion in the Affordable Care Act. Texas did not.
That makes Texarkana perhaps the starkest example of how President Obama’s health care law is altering the economic geography of the country. The poor living in the Arkansas half of town won access to a government benefit worth thousands of dollars annually, yet nothing changed for those on the Texas side of the state line.
None of the low-income Texarkana residents interviewed realized that moving to the other side of town might mean a Medicaid card. In fact, health researchers and those who work with the poor expect very few Americans to move between states to take advantage of the law.
“It’s impossible to understand what it is to move when you have nothing,” said Jennifer Laurent, the executive director of Randy Sams’ Outreach Shelter, where Ms. Marks is staying until she puts together enough savings from her two low-wage jobs to find her own place. “To risk everything — losing your bed, your sense of community — for an uncertain benefit? There’s no way you want to risk that.”
Research on other expansions of government benefits has borne that out: A study in the journal Health Affairs looked at the “welfare magnet hypothesis” and found no evidence that it exists.
“I’m sure, anecdotally, that some people will move,” said Benjamin Sommers, an assistant professor of health policy and economics at the Harvard School of Public Health and a co-author of the study. “But is this a major budget issue for states expanding Medicaid? Will there be a major wave of people moving to get insurance? Probably not.”
Indeed, until the Supreme Court ruling, the Obama administration had intended for the Medicaid expansion in the Affordable Care Act to be universal, covering all adults earning up to 133 percent of the federal poverty line, about $15,500 annually for a single adult or $32,000 for a family of four.
That’s the way it is working out on the Arkansas side of the border, where health clinics and social service agencies are signing up eligible residents, even though this corner of the state is largely Republican and broadly resistant to the health care law.
The expansion is already having an effect on the city’s biggest provider of charity care, the nonprofit Christus St. Michael Health System. “We’re seeing more patients with a payer,” said Chris Karam, its president, referring to those with health insurance coverage.
On the Texas side, though, it’s business as usual. “It makes me mad,” said Mr. Miller, who is not receiving any federal benefits at the moment despite his array of illnesses. “They need to quit playing games with people’s lives. Rich people. Government people.”
Yeah, that would be nice. I believe I’ve mentioned once or twice that there’s an election this fall in which issues like this will be at stake. One hopes the people of Texarkana will recognize the opportunity that gives them. The rest of us, too.