Imagine that instead of running on a mix of state and federal money, Medicaid [1] was funded entirely out of per-town budgets. Rich towns could provide good care to all their inhabitants while poor ones wouldn't be able to afford much at all. Someone who cared just about people in their town and happened to live in a rich town would see this as an improvement, but caring only about people in the same town is too narrow a conception of "our". What about people elsewhere in the state? The country? The world? We're all people, we all count. I agree that we should take care of our own, but I take that to mean everyone.

[1] Medical care for poor people in the United States.