Texas Gov. Rick Perry sent a letter to Health and Human Services Secretary Kathleen Sebelius saying his state would not set up the health insurance exchange required by Obamacare, and would not expand Medicaid, either. While the first thing is flashier, the second thing is more significant. The Affordable Care Act has a pretty easy fix for states that won't set up their own exchanges: the federal government will do it for them. Even before the Supreme Court ruled on the law, the federal government was planning to perform that function for Maine, New Hampshire, and Louisiana.

Supreme Court Chief Justice John Roberts' decision, however, gave states the ability to opt out of the Medicaid expansion — which allows people making up to 133 percent of the poverty level to qualify for coverage through the program. That is a much bigger deal as Medicaid expansion was one of the primary mechanisms that Obamacare was going to be able to achieve its primary goal: increasing the number of people with health care coverage. And Texas, which is the second largest state by population, also has the highest rate of uninsured people in the country at 25 percent.

Perry said in his statement:

"… I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government. I stand proudly with the growing chorus of governors who reject the Obamacare power grab. Neither a 'state' exchange nor the expansion of Medicaid under this program would result in better 'patient protection' or in more 'affordable care.' They would only make Texas a mere appendage of the federal government when it comes to health care."

That means 1.4 million uninsured Texans who would have gotten coverage under Medicaid won't. According to the Kaiser Family Foundation, the Medicaid expansion would have cut the number of uninsured people in Texas by 49.4 percent by 2019.

And the governors Perry is "proudly" joining? They do not have uninsured rates to be proud of, either. Those states are Louisiana (17 percent uninsured), South Carolina (19 percent uninsured), and Florida (21 percent uninsured). The national rate is 16 percent.

As The Washington Post's Sarah Kliff reported last week, five states, plus the District of Columbia, have done the opposite of Perry: expanded Medicaid early. That means more than 500,000 more people have health care coverage. Those states already tend to have lower rates of uninsured people. They are California (19 percent), Connecticut (11 percent), Minnesota (9 percent), New Jersey (15 percent), and Washington (13 percent). 

It should be noted that Perry is not a recent Medicaid hater. In 2010, Perry floated the idea of his state opting out of Medicaid entirely in order to make up the budget deficit. Perry changed his mind after a state study concluded that would be devastating, stripping 2.6 million state residents of their health care coverage and the state of $15 billion in federal funds. The editorial board of the Dallas Morning News was relieved by Perry's change of course, writing, "Speculating on the governor's motives is always a tricky business, and we will not do so here; we will simply be grateful that he backed off, and hope that this dangerous and cruel idea has been quashed once and for all." Being less high-minded than the newspaper, let's note that before Perry became nationally infamous for not being able to remember what government agencies were so terrible he'd eliminate them, he was nationally infamous for suggesting Medicare and Social Security are unconstitutional, dubbing the latter "an illegal Ponzi scheme." Perhaps that's how he wants to be remembered again. He is thinking of running for reelection in 2014, after all.