SAN ANGELO, Texas — When Texas went to court last year to block President Barack Obama's health care overhaul, Gov. Rick Perry pledged to do everything in his power to "protect our families, taxpayers and medical providers." Texas, he said, could manage its own health care.
But in the 11 years the Republican presidential hopeful has been in office, working Texans increasingly have been priced out of private health care while the state's safety net has withered, leaving millions of state residents without medical care.
"Texas just hasn't proven it can run a health system," said Dr. C. Bruce Malone III, an orthopedic surgeon and president of the historically conservative Texas Medical Association.
More than a quarter of Texans lack health insurance, the highest rate in the nation, placing a crushing burden on hospitals and doctors who treat patients unable to pay. Those costs are passed to the insured. Insurance premiums have risen more quickly in Texas than in any other state over the last seven years. And when compared with incomes, insurance in Texas is more unaffordable than in every state but Mississippi, according to the nonprofit Commonwealth Fund.
That has taken a toll, as nearly a third of the state's children did not receive an annual physical and a teeth cleaning in 2007, placing Texas 40th in a state ranking by the fund. Over the last decade, infant mortality rates have risen in Texas while declining nationwide, according to the Centers for Disease Control and Prevention.
Seniors, despite guaranteed Medicare coverage, also are suffering, as nearly one in five ends up back in the hospital within a month of being released, one of the highest readmission rates in the country and a leading indicator of systemwide problems.
Similar health care dynamics drove Obama's push for a national overhaul. In Texas, however, elected officials have done little to address the growing crisis, local health leaders say.
For those who can get it, medical care in Texas can compete with the best in the nation. The state is home to internationally renowned medical and research centers.
Perry promotes the state as a model for a private-sector health care solution. Low taxes and limited government, he and his allies say, lure businesses that can offer private insurance and empower working people to make their own health care choices.
"The governor's primary goal is to create an environment that encourages job creation and provides an environment of independence rather than dependence," said spokeswoman Catherine Frazier. "Texas does provide an adequate safety net to those truly in need … and many individuals simply choose not to purchase health care coverage."
But across Texas, health coverage and health are eroding even in places where jobs are plentiful.
In San Angelo, a growing city in West Texas not far from where Perry was raised, unemployment is just 7.2 percent, lower than it is statewide and nationally. But the waiting room at the federally subsidized Esperanza Clinic is filled every day with working people who have no insurance.
Three-quarters of Esperanza's patients have jobs, said clinic chief executive Mike Campbell. But because many businesses don't offer health benefits, demand at the clinic is skyrocketing. Esperanza saw 13,000 patients last year, up from 11,000 the year before.
At Shannon Medical Center, San Angelo's largest hospital, 30 percent of patients coming to the ER lack coverage, close to twice the national rate.
Texas has among the fewest physicians per capita in the country, according to census data. And this year, the governor and state Legislature slashed funding to train physicians to less than half of what it was a decade ago. Another initiative highlighted by Perry's office to aid community health centers was also cut.