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Gov Perry Refused Medicaid, Now TX Cities Feel the Squeeze

It's well documented that the states (like Texas) who opted out of the Affordable Care Act's Medicaid expansion are at a huge disadvantage - in terms of both the people missing out on health insurance and the federal resources the expansion brings to states.

But looking further into what that really means, an article in Atlantic Cities shows that it's not just that states miss out equally as a whole - it disproportionately hits these states' largest cities.

Put simply: "Because big cities are magnets for the uninsured, with their more extensive health infrastructure, the burden of caring for a state's uninsured disproportionately rests on its urban hospitals and taxpayers."

The problem is magnified in Texas cities. Austin, Houston, Dallas, Forth Worth, San Antonio and El Paso all have local taxing districts to support health care for the indigent, but the suburban and rural counties within driving distance of these urban centers do not. That means it's the cities who are paying for their neighbors to get health care.

Had Texas expanded Medicaid, these cities and their taxpayers would have been relieved of the majority of the costs associated with indigent care. As it stands now, taxpayers in these cities will keep the burden. According to Anne Dunkelberg of the Center for Public Policy Priorities, the cities are "paying 100 percent local tax dollars instead of getting 100 percent federal funding."

For example, in the case of Bexar County's CareLink program, which serves about 60,000 people at a cost of $54 million to county taxpayers. If Medicaid had been expanded in Texas, "many if not all of those people who are currently enrolled in CareLink would have gotten Medicaid insurance, which would have meant that the federal government would be paying for their care, as opposed to the county," says Bexar County public health director Thomas Schlenker. Instead, Bexar County taxpayers have Rick Perry to thank for continuing to pay for these 60,000 people, and many of the other 200,000 uninsured in the county.

The chorus of cities supporting Medicaid expansion is loud and clear. We previously reported that the Chambers of Commerce of five Texas cities (El Paso, Dallas, San Antonio, Fort Worth and Arlington) also called for the expansion in order to bring $100 billion into the state, a stance at odds with Perry for a change. That's because the practical benefits of Medicaid expansion are so compelling that they transcend partisan politics. Or at least should.  

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