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.”…
And moving even a few blocks away might pose an insurmountable challenge. The Salvation Army shelter on the Arkansas side of town charges $6 a night, more than many of the very poor can afford. Randy Sams’, on the Texas side, is free.
“I tell my clients: You’ve got to have paper, or you’ve got to have paper,” Ms. Laurent said. “You’ve got to have money, or you’re going to have to fill out a lot of paperwork for benefits.”
Mr. Tramel said he walked to Texas from Missouri, finding God and kicking a drug habit along the way. The trip took him 11 days. He has no Social Security card, birth certificate or driver’s license, let alone a stable address. The paperwork challenge of establishing residency in a state and applying for benefits, he said, seemed overwhelming to him.