Sunday, June 8, 2014

The economic geography of poverty and the ACA

Annie Lowery reports today for the New York Times under the headline, "In Texarkana, Uninsured and on the Wrong Side of a State Line."  Like 25 other states and the District of Columbia, Arkansas accepted the Medicaid expansion for which the federal government bears 90% of the cost.  Texas, on the other hand, did not, meaning many low-income folks can get free healthcare in Arkansas, but not across the state line inTexas.

With a combined population (both Texas and Arkansas) of about 66,000, the twin cities of Texarkana are not "rural," though the place is hardly a major metropolis either.  (The Texarkana MSA, including all of Bowie County, Texas and Miller County, Arkansas, has a population of 150,000).  I feature the story here for what it says about the geography of poverty and public benefits.  I am also interested in what it says about the immobility of the poor, something that policy-makers often overlook.  It's an issue that arose in relation to the spotty expansion of Medicaid, which some speculated would lead people to cross state lines to receive benefits.  Here's an excerpt:  
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.

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