Texas became the latest and largest state to decide that it will not expand its Medicaid program, according to a letter that Republican Gov. Rick Perry sent to the federal government (PDF).
The letter to HHS Secretary Kathleen Sebelius said the state will not implement either the Medicaid expansion to all residents with incomes of up to 138% of the federal poverty level or launch a state-run insurance exchange. Both provisions would have launched in 2014 as part of the Patient Protection and Affordable Care Act. But the U.S. Supreme Court decision upholding the constitutionality of the law also eliminated its penalties for states that do not undertake the expansion.