One U.S. city is providing a glimpse into the haves and have-nots in the Medicaid expansion fight: Texarkana, half in Texas, half in Arkansas. On the Arkansas side, the people who've fallen through the holes in the safety net have access to Medicaid. In Texas, they don't. Many are employed on one side or the other, but live—some in homeless shelters—on the other. The New York Times takes a close look.
TEXARKANA, Tex. — On a hazy, hot evening here, Janice Marks ate a dinner of turkey and stuffing at a homeless shelter filled with plastic cots before crossing a few blocks to the Arkansas side of town to start her night shift restocking the dairy cases at Walmart.They profile another person at the Texas-side shelter, Ed Miller who is 42 and has congestive heart failure, sleep apnea, and a recent diagnosis of bronchitis. He didn't seem to know about the possibility of Medicaid on the other side until this reporter spoke with him about it—many of the residents don't seem to be aware of it. Many are so used to being rejected by assistance programs they don't want to bother. Some don't have the necessary documentation to apply for assistance, wherever they live.
The next day, David Tramel and Janice McFall had a free meal of hot dogs and doughnut holes at a Salvation Army center in Arkansas before heading back to their tent, hidden in a field by the highway in Texas.
None of the three have health insurance. But had Ms. Marks, 26, chosen to sleep on the side of town where she works, or had Mr. Tramel and Ms. McFall, who are both in their early 20s, made their camp where they had eaten their dinner, their fortunes might be different.
The expansion is already having an effect on the city’s biggest provider of charity care [on the Arkansas side], 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.Business as usual.
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.”