By almost any measure, Texas has one of the worst health care systems in the nation. Its 26 percent uninsured rate - no other state is even close - put its dead last. Overall, health care in the Lone Star State is ranked 44th by America's Health Rankings and 46th by the Commonwealth Fund. Two years ago, it was ranked the 39th healthiest state.
Which is why the Affordable Care Act (ACA) is such a boon for Texas. After all, this week the state Medicaid director revealed that the ACA will dramatically reduce the ranks of the uninsured there to 9 percent beginning in 2014. It's just a shame Governor Rick Perry and his Republican allies are doing everything possible to make sure that never happens.

On Monday, the Houston Chronicle reported hundreds of thousands of Texans can expect to get health care coverage in two years:

The percentage of Texans with health insurance will increase to 91 percent - up from 74 percent today - after the national health care law takes effect in 2014, the state's Medicaid director told lawmakers Monday... An estimated 2.3 million Texans will still lack health insurance after the Affordable Care Act takes effect, partially because undocumented immigrants are not eligible for coverage, State Medicaid Director Billy Millwee told a joint meeting of the House Public Health and Insurance committees.

And that's really good news for Texans. After all, the $300 billion Medicaid program to be expanded by the ACA not only serves roughly 60 million poor and elderly Americans today, but pays for a third of nursing home care in the United States and covers a third of all childbirths. (In Texas, the figure is one-half.) As with Medicare, Medicaid provides insurance for substantially less than private insurers (27% less for children, 20% for adults.) Just as important, an analysis by the National Bureau of Economic Research (NBER) demonstrated that Medicaid coverage significantly improves health and health care outcomes for beneficiaries:

We find that in this first year, the treatment group had substantively and statistically significantly higher health care utilization (including primary and preventive care as well as hospitalizations), lower out-of-pocket medical expenditures and medical debt (including fewer bills sent to collection), and better self-reported physical and mental health than the control group.

Unfortunately, Texas Governor Rick Perry has been at the forefront of the national GOP effort to undo the dreaded "Obamacare." Perry not only had his state join the 26-state lawsuit seeking to overturn the Affordable Care Act before the Supreme Court. As the New York Times reported Monday, he is among the Republican governors leaving the set-up of his state's insurance exchange to the federal government:

Texas is also taking a hard line. "Gov. Rick Perry believes that the federal health care law is unconstitutional, misguided and overreaching," said his spokeswoman, Lucy Nashed. "Because of that, there are no plans to implement an exchange in Texas."

And if he had his way, the health care crisis in Texas would now be much, much worse.
In the fall of 2010, Governor Perry looked to close a yawning budget gap by opting-out of Medicaid altogether. The idea of foregoing $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 now, 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.

Sadly, the Lone Star State's Affordable Care Act ironies don't end there. In July 2010, Governor Perry agreed with radio host Bill Bennett that Texas has the best health care in America:

BENNETT: Thirty seconds on the doctors. You've got the best health care in the country, now I think, don't you? Because of your tort law?
PERRY: We do, yes. I spoke with the doctors yesterday in San Antonio. We've got, you know, three of the great health care -- well not -- three of the great health care regions. When you think about the medical center in Houston, there are more doctors, nurses, researchers go to work there than any other place in the world, every day. You got UT Southwestern up in University of Texas Health Sciences Center, San Antonio, Scott & White. I mean these fabulous health care facilities.

As it turns out, this isn't the first time Perry has made such grandiose claims about the Texas health care mess. In a 2009 Washington Post op-ed titled, "Let States Lead the Way," Perry and Newt Gingrich blasted the Democratic health care reform proposals that were signed into law by President Obama. The duo insisted it is the Lone Star State which should be at the front of that vanguard. In response, an incredulous Ezra Klein asked, "How's that working out?"

Not well at all. That's because Texas is a poster child for a truism of American health care. As the numbers show, health care is worst where Republicans polls best.