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.
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.