They say everything is bigger in Texas. That's certainly the case when it comes to the mega-failure that is the Lone Star State's 46th ranked health care system. Six million people or 24 percent of all Texans--and 30 percent of those ages 18 to 64--have no health insurance. Twenty-two Texas counties are among the nation's 30 worst for health insurance coverage. And because Governor Rick Perry has refused the Affordable Care Act's expansion of Medicaid, 1.5 million Texans will needlessly remain uninsured after January 1. Now, Texas is adding insult to injury by refusing to enforce Obamacare's reforms for insurers, potentially putting the health--and lives--of its residents at risk.
That's the word from the Texas Tribune, which reported that Texas will join Arizona, Alabama, Missouri, Oklahoma and Wyoming in refusing the guarantee that insurance companies follow the ACA's new regulations:

Though Texas will join 26 other states in defaulting to a federal marketplace for purchasing health insurance -- a major component of the Affordable Care Act -- it is one of only six that will not enforce new health insurance reforms prescribed by the law. It's a decision some say could lead to confusion over who's responsible for protecting Texas insurance consumers.

Among other things, those reforms prohibit insurers from refusing to cover those with pre-existing conditions, using "rescission" to drop coverage for those who become sick, discriminating against women and setting annual or lifetime benefits caps. But because the Texas Department of Insurance claims it lacks the authority to enforce those rules, Texas residents may be "bounced back and forth, which is a burden for consumers." If consumers suspect they are being overcharged or denied coverage, ThinkProgress asked:

But who do you complain to?
Usually the answer is your state's insurance department. But the answer is CMS [the federal Centers for Medicare and Medicaid Services] if you live in one of the six states that won't enforce the consumer protections. Unfortunately, if you don't know that, you could spend months oscillating between the state and federal government, trying to figure out if you're getting hoodwinked by your insurance company. And in the meantime, the bills are piling up.

Kevin Lucia, an assistant research professor with the Georgetown University Health Policy Institute's Center on Health Insurance Reforms, explained that enforcement duties are "typically reserved for state insurance departments." Stacey Pogue, a health policy analyst with the Center for Public Policy Priorities, rejected the notion that TDI's hands are tied, pointing out that in the past the agency has responded to federal laws by "taking actions that ensure that they do have oversight."
Now, Texans will have to figure that out for themselves. Meanwhile, the health care mess in Texas will just keep getting bigger.