Texas is number one in the country for people without health insurance. Fully one quarter of Texans have no health insurance at all. Another 26% are on Medicaid, Medicare or other public assistance programs that provide help to get health care, according to the Texas Medical Association. The poverty rate in Texas is also high. Twenty-one percent of adults, 17% of the elderly and 34% of Texas’ children live in poverty. Despite these dire circumstances, Texas Gov. Rick Perry is refusing an offer from the federal government to expand Medicaid, even though the feds will pick up 100% of the cost for the first three years. The reimbursement rate will drop to 90 percent after that. The offer is part of the Patient Protection and Affordable Care Act, or “Obamacare,” a slate of changes to health insurance enacted in the U.S. that Gov. Perry and some other Republican governors dislike. Last July, Perry wrote a letter to the U.S. Department of Health and Human Services last July (pdf) in which he called the offer to expand Medicaid a “gun to the head” of his state. He called the Affordable Care Act a “power grab,” and reiterated that statement in a November 18 blog post on his personal website. By refusing to accept the federal assistance to expand Medicaid, Gov. Perry is turning down $164 billion that would go to help insure the poorest Texas citizens. The assistance would also stimulate Texas’ economy. An analysis by the Center for Public Priorities, a think tank based in Austin, found that every federal dollar the state would spend on Medicaid assistance would return $1.29 in “dynamic state government revenue” over the first ten years of expansion, since Medicaid expenditures generate economic activity while creating a healthier, more productive population.