Debbie Cole, a 51-year-old mother of four, thinks her state should expand Medicaid to give more people the help they need to survive. But when she signed a petition asking Missouri lawmakers to consider accepting Obamacare’s optional Medicaid expansion to provide coverage for additional low-income residents, her request didn’t elicit much sympathy from her Republican state senator, Ed Emery.
His response? If you want Medicaid expansion, just move to a different state.
Cole shared Emery’s letter with public radio station KCUR. According to the copy that KCUR published, Emery thanked his constituent for getting in touch, but explained that he ultimately can’t support Medicaid expansion because it’s the wrong choice for Missouri. “We live in a nation and an era that facilitates physical moves between states. Individuals and families are free to consider moving to states with differing and even contrasting government policies,” Emery wrote.
The state lawmaker told KCUR that he didn’t think “there was anything in there suggesting anybody should move,” but said he simply intended to point out that “we’re free to move from state to state if a state has policies that we like versus policies that we don’t.”
Missouri is one of more than 20 states that have refused to accept generous federal funding to expand their Medicaid programs, one of the key policies that the health reform law implemented to help increase the number of insured Americans. The states that have accepted the optional expansion are seeing historic drops in their uninsurance rates, as well as a host of other benefits like stable funding for hospitals in rural areas. Meanwhile, the states that have refused are preventing millions of impoverished Americans from accessing affordable insurance.
According to a recent study conducted by Harvard researchers, most of those low-income people who are locked out of Medicaid expansion probably won’t actually move to a different state to take advantage of the program. The same thing is true for generous tax breaks; people don’t tend to cross state lines to take advantage of more lenient tax codes.
There are a couple reasons for that. For one thing, impoverished Americans don’t always realize how they could benefit from government benefits in other states. That’s particularly true for the low-income people who live in GOP-controlled states that have resisted Medicaid expansion — since their lawmakers haven’t invested very many resources in education campaigns about Obamacare, those residents are less likely to understand how health reform impacts them personally.
And perhaps more importantly, struggling Americans who are living in poverty simply don’t have the resources to uproot their lives and try their luck in another state. “It’s impossible to understand what it is to move when you have nothing,” Jennifer Laurent, the executive director of a homeless shelter in Texarkana, on the border of Texas and Arkansas, explained in a recent interview with the New York Times. “To risk everything — losing your bed, your sense of community — for an uncertain benefit? There’s no way you want to risk that.”
When it comes to Cole, she plans on staying put in Missouri and continuing to advocate for Medicaid expansion in her home state.