A key part of the ACA is the federal expansion of insurance coverage. A large proportion of the expanded coverage will be achieved by optional, state-level expansion of Medicaid to include those below 138% of the federal poverty line, potentially increasing eligibility of those 65 years and younger by around 12 million. (Perkins, 77) .
Open enrollment for the Affordable Care Act began October 1, 2013 and runs thru to March 31, 2014. The act improves the quality of care that Americans receive by providing better preventative and wellness services and raising the standards of the quality of basic health care coverage. It eliminates pre-existing conditions and gender discrimination meaning no one can be charged more or be dropped from their health insurance coverage for those related reasons. (Richardson & Yilmazer, 200) The Affordable Care Act is the center of the controversy. Healthcare reform has been a great source of great disagreement over the past few decades causing massive political divide between republicans and democrats.
The changes brought in by the ACA have the potential to reignite tensions between federal and state decision makers, Texas in particular. Texas Governor Rick Perry announced that the Lone Star state will not execute major parts of the ACA. "I will not be party to socializing healthcare and bankrupting my state in direct contradiction to our Constitution and our founding principles of limited government," per a statement by the Republican governor. (fwbusinesspress.com) Texas Governor Rick Perry has indicated that Texas will decline to expand coverage. In a July 9, 2012 letter to the Secretary of the U.S. Department of Health and Human Services, Governor Perry called the ACA an intrusion into the sovereignty of the state and noted that it was enlarging a "broken system that is already financially unsustainable." (perryman pdf pg 1) .
Declining to expand Medicaid in Texas involves substantial losses such as foregone economic activity, lower federal matching funds, higher costs for uncompensated care and continuing the ongoing losses that accrue from inadequate mechanisms to provide for the medical needs of indigent Texans.