A More Perfect Union: What do New Yorkers owe Texans?

In the United States, the federal government and the fifty states split the check for many social assistance programs. Within this partnership, considerable discretion is given to each state in defining eligibility for cash welfare, public health insurance, workforce development, and other programs.

This leads to huge variation in benefits across states. On a per capita basis, New York spends triple the amount that Texas does on public welfare. Not surprisingly, outcomes like the uninsured rate and health rankings vary widely between the poor across these states. Is it unjust that the poor in generous states receive much more assistance than the poor in stingy states?

This question has emerged with new force in the wake of the Supreme Court verdict on the Affordable Care Act. In one ruling, the Court voted to uphold the individual mandate. But when it came to the federalism question, the majority of the justices held that Congress may not withhold existing Medicaid dollars from states that decline to expand the program for poor adults. 

This is a big deal. At least a dozen states have indicated that they will not expand Medicaid to poor adults, even though more than 90% of the new funds are covered by the federal government (the states ordinarily pay just under half of the Medicaid tab). If states like Texas and Florida walk away from the billions of federal dollars in the Medicaid deal, poor uninsured adults in those states will be left with no option. Ironically, they will not even be able to purchase subsidized health insurance through the new insurance exchanges, since those programs only kick-in for individuals above the poverty level.

Bill Gardner blogged about this issue, and I followed up in comments on his blog. Bill pointed out – and I agree – that “Americans need and deserve health insurance regardless of where they live.” But I went on to argue that a person needing, or even deserving, something does not necessarily mean that the person has a claim to that good. This is so because claims to assistance can only be recognized where there already exists a standing obligation from someone else (such as fellow citizens or the state) to provide aid. The question that interests me is whether claims of assistance are the same across subnational jurisdictions like cities, provinces, and states.

On my view, claims to assistance arise because of the unique cooperative nature of the welfare state. In a just welfare state, economic and state institutions should be organized on terms that are fair to all members of society, including those who are very badly off, since those people remain part of the social, economic, and civic lifeblood of the state. How extensively these people need to be helped is controversial, of course. My view is that in order to participate in the system of cooperation that doles out huge rewards to the winners, those who are badly off should at least receive a decent minimal income and their children should have a chance to move up the economic ladder.

I do not believe, however, that comparable claims of assistance extend to people that are outside of my welfare state, even though they may also “need and deserve” my assistance as much as my fellow citizens. For example, I do not believe that Americans have an obligation to provide a decent minimal income or comprehensive education to poor people in Mexico or Morocco. (I may still, however, have weak humanitarian duties to assist people in other countries). Again, what gives my fellow citizens a stronger claim on redistributive resources is the shared economic and political system, which requires that the economic resources that arise from our joint cooperation are equitably distributed to all in society. People in other countries stand in some abstract relationship to me, but they are not bound up in the same social and economic institutions (globalization and immigration are changing this reality, however).

What does global justice have to do with inequalities internal to a welfare state? My view is that we can ask an analogous question within the United States. Do rich New Yorkers and poor New Yorkers stand in the same relationship as rich New Yorkers and poor Texans (or rich Texans and poor New Yorkers)? One argument is that no matter where you come from, you share a national identity that trumps the fractionated boundaries of states. We are all Americans, which implies that we share a Constitution, a system of national representation with taxation, we all contribute to our collective security, and so forth.

Yet, if we take the federalist thesis seriously, New Yorkers and Texans have considerable discretion to define their own institutions and identities. For better, or worse, welfare provision has always been largely a local and state prerogative in the United States. In a highly idealized world, citizens might be able to “vote with their feet,” selecting for themselves a state that best embodies their own commitment to either collective security or individual liberty. Predictably, this would lead some businesses and wealthier citizens to abandon the more generous states, and some of the poor to abandon the poorer states (whether this actually happens is somewhat dubious).

From a philosophical standpoint, the question that interests me is whether it could ever be permissible to devise a two-tiered state system, with stronger obligations at the local than at the national level. I believe the answer is a qualified yes. One clear example is the European Union, which is a federation of sovereign states that share common economic and social institutions. Those shared boundaries – and shared currency – mean that members of the European Union have a special obligation to one another, but at the end of the day, Germans may have stronger claims to German assistance, than Greeks do to German assistance, and so forth.

The United States is a fuzzier case. In the late 1770s and early 1780s – after the Declaration of Independence, but before the Constitution – the United States was comprised of more uniquely autonomous political entities. That didn’t work, but when it existed one can fairly say that New Yorkers and Virginians had weak duties to one another. The compromise system that was adopted under the Constitution in 1787 bound the states into a much tighter and interdependent bond (a bond which was tested and briefly severed during the Civil War). The point is the United States in its current incarnation represents just one life stage of a longer and murkier institutional history. It may not be strictly an obligation of justice to bring New Yorkers and Texans together, but doing so may be one step toward a more perfect union.

About Brendan Saloner

I am a postdoctoral fellow at the University of Pennsylvania in the Robert Wood Johnson Health and Society Scholars Program. I completed a PhD in health policy at Harvard in 2012. My current research focuses on children's health, public programs, racial/ethnic disparities, and mental health. I am also interested in justice and health care.
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