There are more uninsured residents of Texas - 6.1 million and counting - than there are people in 33 states. The state's elected officials might be expected, therefore, to cheer a federal health care law that is likely to deliver billions of dollars from Washington to Austin and cover millions of low-income Texans.
Instead, the Republican political leadership has greeted the law and its anticipated costs with open hostility, leaving policy makers to move forward with a complex set of changes even as the governor, attorney general and ranking legislators rage against it. The same awkward dichotomy exists in many of the 21 states that are challenging the health reform act's constitutionality, but are nonetheless required to follow it while their lawsuits meander through the courts.
The antipathy toward the law in Texas is rooted in deeply conservative politics that have been further stirred up in a gubernatorial election year. Because one in four Texans is uninsured, the highest ratio in the country, the law's advocates argue that Texas stands to gain as much as any state. But leaders in Austin are focused on the fiscal threat it poses, which they estimate could cost the state $27 billion in the 10 years beginning in 2014.
"You can say a chicken in every pot, a car in every garage and health care for all, if taken in isolation," said Mr. Abbott, a leader among the Republican attorneys general who are suing the federal government in Florida. "But none of those are good things if it requires breaking the Constitution and breaking the bank to do it."
While Sack found conservatives opposed to the law, he failed to balance his story by calling supporters of Obama-care liberal:
Obama administration officials, while noting the incongruity, said they had been impressed that politically antagonistic states like Texas were complying with, and taking full advantage of, the new law. The Texas Department of Insurance, for instance, has applied for a planning grant to create a more muscular process for reviewing proposed premium increases, a White House priority.
"That's sort of the operational norm in Texas," said F. Scott McCown, executive director of the Center for Public Policy Priorities, which advocates for safety-net programs in the state. "Your leadership may be railing against Washington, but federal supremacy still requires that the people in the trenches get the work done."
Sack admitted that neither the Republican or Democrat candidate for governor favored the health care law and that Perry "would seem to be in tune with public opinion," citing a poll showing 60% of Texans opposed the law, with only 28% favoring it.