How States Rejecting the Medicaid Expansion Sabotaged Their Biggest Cities

[applegrove]

How States Rejecting the Medicaid Expansion Sabotaged Their Biggest Cities

by Emily Badger at the Atlantic Cities

http://www.theatlanticcities.com/politics/2013/11/biggest-obamacare-losers-cities-states-wont-expand-medicaid/7537/

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A similar tension has long existed between urban hospital districts (and the taxpayers who fund them), and suburban and rural counties that sit within driving distance of that care without helping to subsidize it. Texas's largest urban areas, spanning San Antonio, Austin, Houston, Dallas, Fort Worth and El Paso, all currently have large local taxing districts to help support health care for the indigent.

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“The economic argument is completely overwhelming for the big cities,” says Anne Dunkelberg with the Center for Public Policy Priorities in Texas, which has advocated (unsuccessfully) for Medicaid expansion there. “They’re paying 100 percent local tax dollars instead of getting 100 percent federal funding.”

Part of the issue here lies in a fundamental disparity between local governing and statewide politics. Governors and state legislatures have made many of these decisions to reject the Medicaid expansion on philosophical grounds rather than poverty rates or hospital budgets (often despite receiving detailed analyses on those fronts). County and municipal officials, on the other hand, can seldom afford ideology.

“Oh man, I was just talking to a Head Start group this morning,” says Johnson, ticking off all the ways his job as a county commissioner forces him to face actual constituents more often than abstract debate. He hears from struggling residents when he leaves his house, when he walks through his neighborhood, when he goes to the grocery store, when steps into the local Big Lots. “We see them every day, and we get to see a lot of issues and ills that they go through that are based on decisions that the federal government and governors make.”




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[LisaLynne]

1. But sometimes, brown people live in those big cities ...

and we can't be creating a culture of dependency...

[applegrove]

2. Exactly.

[enough]

3. In Pennsylvania, I'm sure this is one of the main reasons our Governor and

state congressional Republicans are dragging their feet on Medicaid expansion. They do everything they can to undermine the cities. It will hurt their hearts to expand Medicaid -- something might improve for somebody in Philadelphia.