Texas has a higher proportion of its population living without health insurance than any other state. But like many other states with lots of poor people, it has the misfortune of being governed by Republicans, which explains why yesterday, Governor Rick Perry announced that the state will refuse to accept the money the federal government is offering to expand Medicaid eligibility to everyone who makes up to 133 percent of the federal poverty level. Perry says that this expansion of Medicaid, which is almost entirely paid for by the federal government, will nevertheless bankrupt the state and put the oppressive boot on the necks of Texans. So he's happy to keep 25 percent of his population uninsured.

In case you're wondering, Texas currently sets eligibility for Medicaid at 26 percent of the federal poverty level, which means that if you earn more than $6,000 a year for a family of four, you're not eligible. That's not a typo. Six thousand dollars a year for a family of four is what the state of Texas considers too rich to get on Medicaid. Look down the list of eligibility levels, and you find that only Alabama, Arkansas, Indiana, and Louisiana set their eligibility lower. It is just so weird how those poor Southern states are the stingiest with health care benefits, isn't it?

It's possible that eventually, Texas and the other states will come around to the expansion of Medicaid. Sarah Kliff explains how this happened with Medicaid's enactment in the 1960s and the Children's Health Insurance Program (CHIP) in the 1990s; conservatives initially resisted, but the money and the opportunity to insure their population eventually became irresistable. One of the key factors then and now is the presence of organized, influential interest groups—particularly the hospitals that have to deliver uncompensated care to the uninsured, costing them billions—that can exert their influence on the government's decisions.

But the Republicans who resisted and then gave in were different from the Republicans of today, and this will be a test of just how far they'll go to make a statement about their hatred of the federal government in general and their hatred of Barack Obama in particular. Today's Republicans are the ones who would turn down a deal offering ten dollars of spending cuts for one dollar of tax increases. But that was a hypothetical question, and this question is very real. There are actual human beings whose lives are at stake. I'd love to hear someone ask Rick Perry this question: Which do you think is worse, someone living without health insurance, or someone getting health insurance through a government program? I'm not sure what he'd say, but his actions say quite clearly that he'd prefer that the person have no health insurance. Of course, we're not talking about him personally, or his kids, or anybody he knows having to go without insurance. We're talking about poor people. So screw them.

Conservatives used to say that a conservative was a liberal who had been mugged. In other words, your abstract political ideology has to shift when it bumps up against unpleasant reality. Something similar can happen with politicians—not that they undergo wholesale ideological shifts, but many have some issue on which they have personal experience that leads them away from their ideology. For instance, Alan Simpson, a staunch conservative in almost every way, has advocated against harsh sentences for minors who commit crimes, because he himself grew beyond his run-ins with the law as a teenager.

As you've probably heard, Ann Romney suffers from multiple sclerosis. In a new video on the Romney campaign's web site, the Romneys talk about how they've dealt with the disease, and encourage people to donate to the National Multiple Sclerosis Society. Which is good, but when you run for president, your own personal life is necessarily political. It's important to be sensitive in how we talk about this, but Jonathan Cohn says exactly the right thing. It's terrific that Mitt Romney has been so devoted to his wife, "But if you have MS, or any other serious chronic illness, you need more than a devoted spouse. You need a way to pay your medical bills." For people with any chronic illness, paying those bills, and getting and keeping coverage in our brutal private insurance system, can be difficult and at times even impossible. Cohn goes on:

Despite what the average voter probably thinks, presidential candidates keep the overwhelming majority of the promises they make. And most of the ones they don't keep aren't because they were just lying, but because circumstances changed or they tried to keep the promise and failed. But that's in the big, broad strokes, while the details are another matter. It's easy to put out a plan for, say, tax reform, but even if you achieve tax reform, it's Congress that has to pass it, and they will inevitably shape it to their own ends. This happened to a degree with President Obama's health care reform: it largely resembles what he proposed during the 2008 campaign, but not entirely. He had said he wanted a public option, for instance, but eventually jettisoned that, and had rejected an individual mandate, but eventually embraced it as unavoidable.

Which brings us to Mitt Romney's health care plan...

The wise Harold Pollack has argued that health care reform is in some ways the best covered social policy story in the history of American journalism. That isn't to say there hasn't been plenty of crappy coverage, but there has never been the same volume of informed and insightful reporting and analysis available in so many places on a pressing policy debate.

And yet it's easy to get depressed about the impact all that good work didn't have...

The latest Kaiser Family Foundation health reform tracking poll is out, and it's pretty seriously depressing. Essentially, as time passes, people understand less and less about the Affordable Care Act. This is the opposite of what the Obama administration and congressional Democrats want, of course, but it springs directly from the way the bill was designed and its implementation scheduled. Basically, we had this big contentious debate, Democrats won, then ... nothing.

Medicare has become the pivotal political issue in Washington, not just in the deficit debate but in the Republican 2012 election as well. GOP primary candidate Newt Gingrich has spent his week furiously backpedaling from his observation on Meet the Press last weekend that Paul Ryan’s Medicare plan amounts to “right-wing social engineering.” The incident shows that a willingness to gut Medicare has become the price of acceptance into the Republican Party.

To hear Republicans tell it, America's governors have all kinds of creative plans for what to do with Medicaid, which is funded jointly by state and federal governments, if only they could be released from Washington's shackles to get all innovative. As Suzy Khimm explains, "Republicans in both houses introduced bills on Tuesday that would eliminate federal regulations that prevent states from trimming their Medicaid rolls or erecting new barriers to enrollment." Now that's how you save money: throwing people off Medicaid, or making it next to impossible for them to get it in the first place. Innovative!