On Monday, Texas Republican Senators Ted Cruz and John Cornyn joined Governor Ricky Perry to present a united front against the expansion of Medicaid in the Lone Star State. While Perry called Medicaid a "broken system," Cruz warned accepting Obamacare's massive federal assistance "will worsen health care options for the most vulnerable among us in Texas."
Of course, that knee-jerk response from the likes of Rick Perry should come as no surprise. After all, in 2010 Governor Perry agreed with the claim that Texas has "the best health care in the country." And just the year before, Perry and Newt Gingrich co-authored a Washington Post op-ed ("Let States Lead the Way") which offered Texas as a role model for health care reform across the nation.
As it turns out, Texas is a role model only in the sense of being a horrible example to be avoided at all costs. As the numbers show, by almost every objective measure the Texas health care system ranks among the very worst in the nation.

That starts with leading the U.S. in the percentage of uninsured residents, the very crisis the Medicaid expansion was designed to help alleviate. Over six million Texans have no health insurance, leaving 24 percent of residents (and over 30 percent between the ages of 18 and 64) without coverage. As a result, The Hill noted, Texas "confronts billions of dollars' worth of uncompensated hospital care every year" which add an estimated $1,800 a year to the average private insurance premium in in the state. In its last state health care scorecard for 2009, the Commonwealth Fund rated Texas dead last in access to medical care. Across all five indicators (see table above), Rick Perry's state ranked a dismal 46th.
As The Hill pointed out, accepting the Medicaid expansion would be a sweet deal for Texas:

Allowing the expansion, in the case of Texas, would insure 1.5 million low-income Texans and bring $90 billion in federal funding to the state over the first decade, according to estimates.

The San Antonio Express-News explained just how sweet:

A study commissioned by Texas Impact and Methodist Healthcare Ministries estimates that the federal government will send Texas $100 billion over the next decade to pay for Medicaid expansion if the state invests about $15 billion.

While other Republican governors including Chris Christie (R-N) and Jan Brewer (R-AZ) saw the light in a program that covers 100 percent of the Medicaid expansion through 2017 and 90 percent after that, Perry and his fellow Texas Republicans are still saying no. And that opposition could have a real body count, both politically and literally. Latino voters, a block which is rapidly transforming politics in Texas, overwhelming support Obamacare by a 48 to 19 percent margin. As a New England of Journal Medicine article recently warned, without the Medicaid expansion many poor Americans will just go without health care, which could result in an estimated 2,938 unnecessary deaths a year in Texas alone.
As it turns out, the rolls of the uninsured in Texas would have been much larger if Rick Perry had gotten his way in the fall of 2011. With his then cash-strapped state already leading the nation in the percentage of uninsured residents, Perry floated the idea of opting out of Medicaid altogether. His scheme to forego $15 billion in federal funds (60% of his state's Medicaid costs) went by the wayside when a study by the state Health and Human Services Commission found that "up to 2.6 million Texans could lose health coverage if the state opts out of Medicaid." Facing a massive $27 billion, two-year deficit due in part to reckless tax cuts and a refusal to raise revenue, Lone Star State Republicans were nevertheless briefly looking at savaging its Medicaid program now serving 3.1 million people:

The total effect of the cuts -- estimated at $7.6 billion a year, or roughly a third of Texas' Medicaid spending -- will kill jobs, strain the state's economy and put people's lives at risk, experts across the state have said in recent weeks.

Thanks to the current energy boom and the national economic recovery, the budgetary picture in Texas has improved dramatically. As the New York Times reported in January, Texas is now forecasting an $8.8 billion surplus. Nevertheless, Governor Perry has rejected restoring some of the funding lost in the draconian spending cuts of 2011 and 2012. Instead, he's calling for $1.8 billion in tax cuts.
As for putting some of those dollars towards expanding Medicaid to cover millions of Texans, Perry and his GOP allies on Monday said no way. As Politico reported:

"Texas will not be held hostage to the Obama administration's attempt to force us into this fool's errand," he said, flanked by Republican Sens. John Cornyn and Ted Cruz and Reps. Joe Barton and Michael Burgess.

The real hostages, of course, are the 1.5 million Texan residents who could get medical coverage, but won't. Those Ted Cruz called the "most vulnerable among us in Texas" will simply have to take comfort in Rick Perry's boasting that Texas has "the best health care in the nation." Besides, it could be worse; they could live in Mississippi.