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The Affordable Care Act, or Obamacare, is highly unpopular in both Texas and Arkansas, but the sharply different approaches the states have taken is evident in the availability and cost of health care — in the span of a few miles.

Arkansas uses federal money as part of a hybrid program approved three years ago to buy private insurance for the poor. It was amended this year and to encourage the unemployed to look for work and for some enrollees to pay part of their premiums.

Since 2013, the rate of uninsured Arkansas adults dropped from 22.5 percent to 9.6 percent in 2015, according to a Gallup-Healthways Well-Being Index.

Texas lawmakers wouldn’t consider Medicaid expansion and has an estimated 4.6 million uninsured among its about 27 million residents.

In Arkansas, the poor go to the doctor sooner and to the emergency room less. In Texas, about 8 percent of poor residents used the emergency room as their doctor in 2013, according to a recent Harvard University public health study. In 2014, it was 10 percent, and jumped to 11.3 percent last year.

“The ER is the last place in the world you want to send someone who doesn’t have an emergency,” said Dr. Joe Thompson, director of the Little Rock-based nonpartisan policy center Arkansas Center for Health Improvements. “It’s expensive; there is no continuity of care, no follow-up,”

Near Texarkana, Arkansas, Erika Castaneda told the Houston Chronicle she can now afford the co-payment to treat her diabetes after not being able to afford the $75 cost of going to a health clinic.

Castaneda, 35, said she and her husband make about $3,000 per month to support themselves and four children. In 2014 she applied for and was approved for the Arkansas program, but said she didn’t believe it until she handed over her insurance card and paid $8.

“Dang, this feels good,” Castaneda said she thought, tucking away the rest of the money she had brought just in case.

Across the state line in Texarkana, Texas, nurse Cheryl Nunn said she and her husband have $165,000 in medical bills to pay on her $35,000 salary and his $4,104 in annual disability payments.

Nunn, 51, has heart disease, suffered a blood clot in her lungs and her husband is disabled following a heart attack.

She said she’s heard about Arkansas’ program and wishes Texas would do something similar.

“There’s just no in-between in Texas,” she said. “It’s black or white. Apparently in Arkansas, there is gray. I guess I’m just stuck.”

Topics Texas