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"  Even over the telephone, Jose Camacho sounded tired. As the executive director of the Texas Association of Community Health Centers, Camacho&amp;#039;s job is to oversee clinics all over the state that serve the poorest of the poor. Most of those patients either are on some kind of government program \u2014 Medicare or Medicaid \u2014 or are completely uninsured. One of the provisions of the Affordable Care Act allows Medicaid to cover another 17 million Americans who currently are uninsured. Under the terms of the ACA, starting in 2014, the federal government will pick up 100 percent of the cost of this expansion, and it will still cover 90 percent of it after 2020. (At the moment, the feds pick up 57 percent of the tab.) In essence, the ACA gives the states free money with which to cover their uninsured citizens. Free money! Once the ACA is fully implemented, it is estimated that nearly 1.8 million more citizens in Texas will have some kind of health care. Accordingly, by mid-July, the governors of five states, all of them Republicans, had announced their intention to refuse the free money (!). One of them is Rick Perry, the governor of Texas. In fact, two weeks ago, Perry announced that Texas would be opting out of participation in practically the entire Affordable Care Act. No Medicaid expansion. No insurance exchange. None of it. This was because, some time ago, somebody fed Rick Perry some muck about states rights and the 10th Amendment, and Perry has proven capable of having only one idea at a time, so he&amp;#039;s been out in the yard playing with this one for the past few years. And this is what Perry said in announcing that he would be opting out of the new programs: &amp;quot;I stand proudly with the growing chorus of governors who reject the Obamacare power grab... Neither a &amp;#039;state&amp;#039; exchange nor the expansion of Medicaid under this program would result in better &amp;#039;patient protection&amp;#039; or in more &amp;#039;affordable care.&amp;#039; They would only make Texas a mere appendage of the federal government when it comes to health care.&amp;quot; Which is why Jose Camacho sounded so tired. &amp;quot;Well, we&amp;#039;re still studying the impact,&amp;quot; Camacho said. &amp;quot;Our estimates are that, with the Medicaid expansion, we&amp;#039;d be able to serve somewhere between 400,000 and 500,000 additional patients. Some of them would be on Medicaid, and some of them would be uninsured. Now, we won&amp;#039;t be able to do that.&amp;quot; And Camacho&amp;#039;s people have their work cut out for them in Texas. Texas leads the nation with 25 percent of its population uninsured. A report issued by the federal Agency for Healthcare Research and Quality ranked Texas last in delivering health care to its citizens. Even more recently, a report produced by the George Washington University School of Public Health on behalf of the RCHN Community Health Foundation analyzed the consequences of the refusal by various states to participate in the programs covered under the ACA. This, the report states, not only would prevent those citizens without coverage from obtaining it, the refusal also would put an intolerable stress on what clinics like those in Jose Camacho&amp;#039;s organization already provide. It would appear that this is the price Rick Perry is willing for his constituents to pay so he can pretend to be faithful to the spirit of John C. Calhoun: It is, of course, too early to know with real certainty which states will be affected. But states whose Governors had by mid-July been relatively outspoken about rejecting Medicaid expansion funding include Florida, Louisiana, Mississippi, South Carolina, and Texas. In those states alone, as many as 5.5 million individuals who would otherwise have received coverage under Medicaid will remain uninsured. Republican Governors in an additional five states (Iowa, Missouri, Nebraska, New Jersey and Nevada) have indicated that they are inclined not to expand coverage, although a final decision has not been reached. Those states represent an additional 1.4 million uninsured individuals who would likely have been coveredunder Medicaid. If these 10 states ultimately were to decline Medicaid expansion, coverage for nearly 6.9 million low-income persons would appear to be at risk. Health center growth in these states would decline from a projected 8.3 million additional patients served by 2019 to 6.8 million.  &amp;quot;The people who work in our clinics do it because they like the work,&amp;quot; Jose Camacho said, wearily. &amp;quot;Those folks are the first line of defense for most poor people. Now, with Texas refusing the money, they&amp;#039;re going to be the ones who have to tell a person with a serious illness that he can&amp;#039;t afford to get treatment. They&amp;#039;re going to be the ones who have to tell the parents of a sick child that needs to see a specialist, or needs to have a procedure done, that they have no way of paying for it. It&amp;#039;s just a tragedy.&amp;quot; "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.esquire.com/news-politics/politics/a15045/health-care-clinic-blues/>