"Through its proposed expansion of Medicaid, the PPACA would simply enlarge a broken system that is already financially unsustainable," Perry told Sebelius. "Medicaid is a system of inflexible mandates, one-size fits-all requirements, and wasteful, bureaucratic inefficiencies. Expanding it as the PPACA provides would only exacerbate the failure of the current system, and would threaten even Texas with financial ruin."
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The lambasting of the Medicaid expansion comes from the governor of a state that already operates one of the nation's most restrictive Medicaid programs. As a result, the U.S. Census Bureau
reports that 26.3% of Texas residents were uninsured in 2009, the highest rate in the nation.
Instead of expanding Medicaid, Perry and other governors have called for block grants
of federal money so that states can decide for themselves the best way to provide coverage for the uninsured.
With the state government opposed to expanding the Medicaid rolls, the burden of providing for the uninsured in Texas, as in many states, falls upon counties and municipalities. Those local officials who are already facing tight budgets are understandably not so eager to reject the federal government's offer to pay for 100% of the Medicaid expansion in the first three years and for 90% of the expansion beyond 2020.