However, as we have seen over the last three years, the politics of "Obamacare" are so toxic that at least 14 states have said they will not expand coverage. "If the discussion is purely about money, it's hard to just walk away," says Matt Salo, executive director of the National Association of Medicaid Directors. "But this is not just about money. This is very much about politics and ideology."
More than any other state, Texas has come to represent "not just 'no' but 'hell no'" opposition to Obamacare, even though the Lone Star State has the highest percentage of uninsured citizens in the United States. It has been estimated that as many as 1.7 million Texans could gain coverage with the expansion, which would also funnel about $90 billion in federal dollars into the state over the next decade.
Governor Rick Perry and other key Republican leaders, however, have led the opposition, with Perry calling the expansion plan "a misguided, and ultimately doomed, attempt to mask the shortcomings of Obamacare. It would benefit no one in our state to see their taxes skyrocket and our economy crushed as our budget crumbled under the weight of oppressive Medicaid costs."
Instead of another federal mandate, Perry has called for "the flexibility to care for our own in a manner that makes sense both effectively and financially."
The problem is that the Texas legislature, which meets once every two years, adjourned this spring without taking any action on an alternative to the federal expansion plan. They could call a special legislative session to address the expansion, or it could be done administratively through the Perry administration, but those options appear unlikely right now.