As Annie Lowrey described, which side of town one lives on can determine whether a poor person receives Medicaid benefits if the town is on a border between a state which participates in the expanded Medicaid program and one which does not. The Affordable Care Act provides for expanding Medicaid benefits with the federal government paying most of the cost, but many Republican-controlled states have chosen not to participate in the program:
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.
After the Supreme Court decided in 2012 that states could not be compelled to expand Medicaid to cover more of their low-income residents, many politicians voiced fears that the poor in states that opted out of the expansion might flood into states that opted in.
Thus far, 26 states and the District of Columbia have chosen to extend Medicaid, encouraged by the promise that the federal government will shoulder 90 percent of the cost indefinitely. The others — including Texas — have so far declined.
But 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…
The disparities among states have left about eight million low-income adults ineligible for Medicaid and have widened the difference in what federal safety-net benefits are available to similar families in different states. There are a number of border communities where one state is expanding Medicaid and the other is not: West Memphis, Ark., and Memphis; Chicago and Gary, Ind.; Washington’s Maryland suburbs and those in Northern Virginia; and Spokane, Wash., and Coeur d’Alene, Idaho.
There is currently a battle in Virginia over whether to accept the program. In order to prevent this, the Republicans are attempting to flip the state Senate by offering a Democratic member what might be an illegal bribe to step down.
The expanded Medicaid program is both providing many people with needed health are coverage, and is also improving profits for hospitals which no longer have to provided reimbursed care.