The state of Texas has turned away billions of dollars that could have provided health care to 1.5 million of its poor residents. Texas has refused to participate in Medicaid expansion because it is part of President Obama’s Affordable Care Act. While the state has the highest percentage of uninsured residents in the country, and the state’s share of the cost would have been only 7 percent of the total, Texas Republicans felt that “even $1 in the name of ‘Obamacare’ was a dollar too much,” NPR reports.

The proposal, which was submitted to Governor and presidential hopeful Rick Perry on Sunday says that state health officials “may only provide medical assistance to a person who would have been otherwise eligible for medical assistance,” according to Think Progress.

Governor Perry and Texas Republicans are determined to reject the aid for purely political reasons, because it comes from President Obama, even at the cost of the well-being of millions of their poor, elderly, and disabled. According to Governor Perry, “Texas will not be held hostage by the Obama administration’s attempt to force us into this fool’s errand of adding more than a million Texans to a broken system.”

Medicaid expansion under the Affordable Care Act was upheld by the Supreme Court in 2012; however, the Court limited the federal government’s ability to penalize states who don’t comply. The expansion benefits low-income individuals and families with incomes up to 133 percent of the federal poverty level ($30,675 for a family of four in 2012), and will particularly help childless adults, who, in more than 40 states, cannot currently qualify for Medicaid, according to the American Public Health Association.

Not only are low-income residents being denied a chance to qualify for health care under Medicaid expansion, but most are also prohibited from receiving tax credits that could help subsidize the purchase of private health insurance. According to the New York Times,

More than half of all people without health insurance live in states that are not planning to expand Medicaid. People in those states who have incomes from the poverty level up to four times that amount ($11,490 to $45,960 a year for an individual) can get federal tax credits to subsidize the purchase of private health insurance. But many people below the poverty line will be unable to get tax credits, Medicaid or other help with health insurance.

Tom Banning, chief executive officer of the Texas Academy of Family Physicians, lobbied hard for Medicaid expansion, and told NPR that refusing to expand Medicaid will only shift costs throughout the health care system:

These people don’t choose to get sick. When they do, they’re going to access our health care system at the most inefficient and expensive point, which is the emergency room. And it’s going to cost the taxpayers, and it’s going to cost employers a lot of money to care for them. And we’re going to be forgoing billions of dollars that the feds have set aside for the state to pay for and provide this care.

Of course, the well-being of the poor is of no concern to some elected officials, particularly when supporting the needy would require accepting the president’s Affordable Care Act instead of drawing lines in the sand. Some believe that there could be another presidential bid for Governor Perry in 2016, which will require all the support he can muster from his Tea Party base, and it would benefit him to oppose the president.  

Alisha is a writer and researcher for Ring of Fire.