100 things to know about healthcare in Texas

As the saying goes, "everything is bigger in Texas," and healthcare is no exception. The Lone Star State is home to some of the largest hospitals and health systems in the country and also houses three of the top ten most populated cities in the United States — Houston, Dallas and San Antonio. The following 100 points offer information on and insight into healthcare delivery in the state of Texas, one of the most active states in the industry.

1. There are 630 hospitals with 83,000 licensed beds in Texas, according to the Texas Hospital Association.

2. Harris County, which includes Houston, is home to 80 hospitals — the highest number of any county in Texas, according to the THA. Dallas County has the second-highest number of hospitals with 42, then Tarrant County — including Fort Worth — has 39 and Bexar County — including San Antonio — has 32.

3. According to the THA, 27 percent of Texas hospitals are located in rural areas, and 73 percent of Texas hospitals are located in urban areas.

4. There are 26 Urgent Care Association of America-certified urgent care centers in Texas, which is the seventh most in the nation. The amount of urgent care centers in Texas — and across the nation — is growing rapidly due to long waits for primary care physicians, expensive and overcrowded emergency rooms in hospitals and the growing popularity of treatment for non-emergency conditions at a lower cost provided in urgent care centers.

5. Texas is the sixth-least expensive state for personal health spending per capita. The average cost of personal health spending per capita in Texas is $5,924, whereas the average cost of personal health spending per capita in Massachusetts — the most expensive state — is $9,278.

6. Governor Rick Perry notified the government in November 2012 that Texas would not set up a state-run exchange for health insurance. "This is a federally-mandated exchange with rules dictated by Washington. It would not be fiscally responsible to put hard-working Texans on the financial hook for an unknown amount of money to operate a system under rules that have not even been written," said Gov. Perry in a letter to the Secretary of Health and Human Services. Instead, Texas residents enrolling in a marketplace plan must do so under the federally facilitated marketplace.

7. Texas has the second most Health Professional Shortage Area designations in the country. According to the HPSA data, there are a total of 375 primary care HPSA designations in Texas. California leads the nation with 540 HPSA designations, and Michigan with 293 is third.

8. Texas is home to nine medical schools:

•    Baylor College of Medicine (Houston)
•    Texas A&M Health Science Center–College of Medicine (Bryan)
•    Texas Tech University HSC–Paul L. Foster School of Medicine (El Paso)
•    Texas Tech University HSC School of Medicine
•    University of Texas HSC–San Antonio School of Medicine
•    University of Texas Medical Branch School of Medicine (Galveston)
•    University of Texas Medical School at Houston
•    University of Texas SMC at Dallas–Southwestern Medical School.
•    University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine

Leading health systems in Texas
The following are ten of the largest health systems in Texas, listed in alphabetical order.

Baptist Health System (San Antonio)

9. Baptist Health System includes five acute-care hospitals and 1,753 beds. Its parent company, Dallas-based Tenet Healthcare, is a for-profit hospital chain, operating 78 hospitals — 19 of which are located in Texas, 173 ambulatory surgery centers and outpatient facilities and five health plans through it subsidiaries.

10. Baptist Health was acquired by Tenet Healthcare last fall when the hospital operator completed a merger with Nashville, Tenn.-based Vanguard Health Systems.

11. BHS Accountable Care, LLC, based in San Antonio is the ACO made up of Baptist Health System and its clinically integrated physician network, which joined the Medicare Shared Savings Program in July 2012.

12. Recently, Tenet Healthcare and UnitedHealthcare signed a three-year contract providing UnitedHealthcare's commercial and Medicare Advantage members with in-network access to Tenet's facilities.

13. Graham Reeve is the CEO of Baptist Health System and the San Antonio market for Tenet Healthcare.

Baptist Medical Center (San Antonio)

14. Founded in 1903, Baptist Medical Center serves as the flagship hospital of Baptist Health System, now a part of Tenet, with 1,527 beds.

15. Baptist Medical Center is one of the top grossing for-profit hospitals in the nation at $5.3 billion in gross revenue.

16. Baptist Medical Center was listed as one of the top ten hospitals with the most emergency room visits for both admitted and not admitted patients at 156,100 in 2013.

Baylor Scott & White Health (Dallas)

17. Baylor Scott & White Health was formed following the 2013 combination of Baylor Health Care System and Scott & White Healthcare.

18. Baylor Scott & White includes over 45 hospitals, 5,216 licensed beds, more than 500 patient care sites, more than 6,000 affiliated physicians and the Scott & White Health plan.

19. Joel T. Allison is CEO of Baylor Scott & White Health in Dallas. Mr. Allison was formerly CEO of Dallas-based Baylor Health Care System, which merged with Temple, Texas-based Scott & White Healthcare in October 2013.

20. Robert W. Pryor, MD, is president, COO and CMO of Baylor Scott & White Health. Dr. Pryor took on his role when the system formed from the 2013 merger of Dallas-based Baylor Health Care System and Temple, Texas-based Scott & White Healthcare. Dr. Pryor was formerly CEO of Scott & White.

21. Baylor Scott & White Quality Alliance is the clinically integrated network and ACO of Baylor Scott & White Health Care System. The ACO finalized a commercial coordinated care contract with Aetna in November 2012. BQA includes approximately 1,400 independent and 600 employed physicians.

22. Two Baylor Scott & White Health hospitals ranked in the top 10 U.S. News & World Report Best Hospital rankings in the state of Texas. Baylor University Medical Center at Dallas is ranked number one in the Dallas metro area and number two in all of Texas. Scott & White Memorial Hospital is ranked number 10 in all of Texas.

Baylor University Medical Center at Dallas

23. Founded in 1903, Baylor University Medical Center has 1,079 licensed beds and serves as the flagship hospital of Baylor Health Care System.

24. John B. McWhorter, III, is the president of the Baylor University Medical Center and is the senior vice president of Baylor Health Care System. He has been part of the BHCS team for more than two decades after beginning his career as an administrative resident in 1984, and he's held various leadership and executive positions at Baylor hospitals throughout his career.

25. Baylor Medical Center is ranked the second best hospital in Texas by US News and is nationally recognized in 6 adult specialties.

CHRISTUS Health (Irving, Texas)  

26. CHRISTUS Health is a nonprofit, Catholic health ministry comprised of more than 40 hospitals and facilities across 60 cities in Texas, Arkansas, Iowa, Louisiana, Missouri, Georgia, New Mexico and Mexico.

27. The system employs approximately 30,000 people and has more than 9,000 physicians on its medical staff.

28. Ernie Sadau has served as president and CEO of CHRISTUS Health since 2011. He joined CHRISTUS as senior vice president of patient and resident care operations in 2006.

29. George Conklin is senior vice president and CIO of CHRISTUS Health. Mr. Conklin has served as senior vice president and CIO of CHRISTUS Health since the system's formation in 1999. He was responsible for merging the operations of two delivery systems — Houston's Sisters of Charity Health Care System and San Antonio's World Health System, integrating technical operations and consolidating information to a single standards-based set for the entire system.

30. In April, CHRISTUS Health acquired a 50 percent ownership interest in Clinica San Carlos de Apoquindo UC, a full-service hospital based in Santiago, Chile. CHRISTUS officials said the acquisition will help the system's "strategic plan to grow its healthcare presence in Santiago…and the expansion will be key in extending high-quality healthcare to the people of Chile who need it."

31. Most recently, CHRISTUS Health has applied to become the fifth health insurance company offering plans on the New Mexico Health Insurance Exchange. CHRISTUS will join New Mexico Health Connections, Presbyterian Health Plan, Blue Cross Blue Shield of New Mexico and Molina Healthcare of New Mexico. Group rates are set to be released in late August and individual rates will soon follow.

Christus Spohn Hospital Corpus Christi–Memorial

32. CHRISTUS Spohn Hospital Corpus Christi–Memorial has 1,049 licensed beds and is centrally located in the Corpus Christi Bay area.

33. Pamela Robertson is the president and CEO of CHRISTUS Spohn Health System serving a 15-county region with a mix of tertiary, trauma and rural facilities. She was most recently executive vice president and COO for the CHRISTUS Spohn Health system.

34. Amidst many objections by the surrounding communities, Christus Spohn is currently preparing a $325 million project to tear down the Christus Spohn Hospital Corpus Christi–Memorial and starting from scratch in a lot adjacent to it.

East Texas Medical Center Regional Healthcare System (Tyler, Texas)

35. East Texas Medical Center Regional Healthcare System, which includes 14 hospitals and has more than 600 physicians, has served its local East Texas communities for more than 60 years.

36. Roughly half of the system's 5,000 jobs are maintained in East Texas' smaller cities, making it one of the top employers in rural communities.

37. Elmer G. Ellis serves as president and CEO of ETMC Regional Healthcare System. In 2006, he received the Texas Hospital Association's Earl M. Collier Award for Distinguished Health Care Administration. In December 2011, East Texas Medical Center Tyler named its new emergency center the Elmer G. Ellis Trauma Center for Mr. Ellis' leadership and commitment to the community.

38. ETMC Regional Healthcare System's East Texas Medical Center in Tyler ranks in the top 25 hospitals in the Best Hospital rankings by US News.

HCA Gulf Coast Division (Houston)

39. With a total of 3,714 licensed beds, HCA Gulf Coast Division — a division of Nashville, Tenn.-based Hospital Corporations of America — is a network of 13 hospitals, 9 ASCs, 19 emergency centers, 14 diagnostic imaging facilities and a cancer center serving the Greater Houston and South Texas areas.

40. Maura Walsh is the president of the HCA Gulf Coast Division. Ms. Walsh joined HCA in 1987 serving as CEO for three different hospitals within the division. She is an active board member for the Greater Houston Partnership, the American Diabetes Association-Houston and the American Heart Association-Houston and is a fellow of the American College of Healthcare Executives.

41. Recently, HCA reported a 14 percent rise in Q2 profit. The net income rose from $423 million in the second quarter of 2013 to $483 million this year. Revenues in the second quarter totaled $9.23 billion, up from $8.45 billion in the second quarter of 2013.

Houston Methodist System

42. Houston Methodist is a five-hospital, nonprofit healthcare organization affiliated with the Texas Annual Conference of the United Methodist Church. The system has a total of 1,633 beds and 14,826 employees.

43.  In May, Houston Methodist announced an $870 million project to upgrade its Houston Methodist Hospital at the Texas Medical Center in addition to constructing a new facility in The Woodlands, set to open in 2017.

44. Marc L. Boom, MD, FACHE, is the president and CEO of Houston Methodist System. He is board certified in both internal medicine and geriatric medicine. He is also a fellow of the American College of Physicians, an assistant professor of medicine at Ithaca, N.Y.-based Weil Medical College of Cornell University and an adjunct professor of management at Houston-based Rice University.

Houston Methodist Hospital

45. Serving the greater Houston area, Houston Methodist Hospital of Houston-based Methodist Hospital System is a nonprofit hospital with 897 licensed beds and 1,852 affiliated physicians.  

46. Houston Methodist Hospital is ranked the number one best hospital in Texas and is nationally ranked in 11 adult specialties by US News.

Memorial Hermann Healthcare System (Houston)

47. With 12 hospitals, numerous specialty services and 5,500 affiliated physicians, Memorial Hermann Healthcare System is the largest non-profit health system in southeast Texas.

48. The Memorial Hermann Physician Network includes physicians from Memorial Hermann Medical Group and UTHealth, as well as private physicians and specialists. In addition, the system includes MHealth and MHealth Insurance Company.  

49. Dan Wolterman is the president and CEO of Memorial Hermann Healthcare System. Mr. Wolterman has been with Memorial Hermann since 1999 when he joined as senior vice president. He was named to lead the integrated health system in 2002. Before joining Memorial Hermann, he served as senior vice president of the Sisters of Charity of the Incarnate Word Health Care System in Houston. He also serves on the Greater Houston Partnership's Health Care Advisory Committee.

50. The Memorial Hermann Accountable Care Organization joined the Medicare Shared Savings Program in July 2012. Memorial Hermann ACO and MHMD, the system's physician network, launched accountable care partnerships with Aetna in April 2013 and Blue Cross Blue Shield of Texas in September 2013. MHMD's 3,500 physicians and MHACO's 1,900 physicians serve greater Houston and its surrounding areas.

51. In May, Memorial Hermann announced a $650 million project to upgrade its Texas Medical Center campus. The expansion is projected to add 1.34 million square feet including 160 additional beds, 24 new operating rooms and 16 emergency room bays.

52. In July, Memorial Hermann Healthcare System was named one of the nation's "Most Wired," by the American Hospital Association for the tenth year in a row.

Memorial Hermann-Texas Medical Center (Houston, Texas)

53. Founded in 1925, Memorial Hermann-Texas Medical Center serves as the primary teaching hospital for The University of Texas Health Science Center at Houston Medical School with 908 licensed beds.  

54. Craig Cordola is the CEO of Memorial Hermann-Texas Medical Center and associate dean for hospital affairs at The University of Texas Health Science Center at Houston Medical School. Prior to his position at Memorial Hermann-Texas Medical Center, Mr. Cordola was CEO of Children's Memorial Hermann Hospital. Mr. Cordola is also a board member of the University Health System Consortium.

55. Memorial Hermann-Texas Medical Center is nationally ranked in pediatrics and is also ranked in the top 15 hospitals in Texas by US News.

Methodist Health System (Dallas)

56. Methodist Health System is a nonprofit health system affiliated by covenant with the North Texas Conference of The United Methodist Church comprised of 1,156 active physicians and 1,161 licensed beds.

57. Stephen Mansfield, PhD, has led Dallas-based Methodist Health System as president and CEO since 2006. Dr. Mansfield is the current chairman of the Dallas Regional Chamber and serves on boards for the Dallas County Community College District Foundation, Dallas Citizens Council and North Texas Commission. He is also a board member for his alma mater, the University of Tennessee at Martin. Previous to his position at Methodist Health System, he spent seven years as president and CEO of the five-hospital St. Vincent Health System, based in Little Rock, Ark.

58. More than 200 physicians are partnered with the Methodist Patient-Centered ACO in Dallas, which is affiliated with Methodist Health System and was selected to participate in the Medicare Shared Savings Program in July 2012. The ACO serves approximately 13,000 patients.

Texas Health Resources (Arlington)

59. Texas Health Resources includes 25 owned, operated, joint ventured or affiliated acute-care and short-stay hospitals.

60. The system also includes 18 outpatient facilities, more than 250 additional community access points and a physician group with more than 500 physicians and 200 physician assistants and nurse practitioners.  

61. Texas Health Resources includes the Texas Health Research & Education Institute, which conducts research that contributes to the prevention, diagnosis and treatment of disease in addition to offering continuing medical education for physicians and other healthcare professionals.  

62. Douglas D. Hawthorne is currently the CEO of Texas Health Resources. He announced his resignation in January to step down Sept. 1 from his role at the system. Mr. Hawthorne helped lead the formation of Texas Health Resources, in 1997. He serves as the chair of the Health Leadership Council Executive Task Force on the Uninsured and is a member of the American Hospital Association's President's Forum.

63. Barclay Berdan will replace Doug Hawthorne effective Sept. 1. He previously worked as senior executive vice president and COO of the system in 2012.

Texas Health Presbyterian Hospital Dallas

64. Texas Health Presbyterian Hospital Dallas is an 898-bed facility treating the North Texas area.

65. Texas Health Presbyterian Hospital Dallas is named in the top 15 best hospitals in Texas and in the top five in the Dallas-metro area by US News.  

66. Britt Berrett, PhD, FACHE, is the president of Texas Health Presbyterian Dallas. He joined Texas Health Presbyterian Dallas in 2010 after 10 years as president and CEO of Medical City Dallas Hospital. He is a fellow in the American College of Healthcare Executives.

University of Texas System (Austin)

67. The University of Texas System consists of six health institutions including the ownership of three teaching hospitals and is affiliated with the University of Texas based in Austin.

68. The MD Anderson Cancer Center of the UT System has ranked as one of the top two cancer centers in the nation for the last 25 years by U.S. News. MD Anderson is the No. 1 recipient for grants awarded and total grant dollars by the National Cancer Institute, and the NCI has designated it as one of just 41 comprehensive cancer centers in the nation.

Other leading hospitals in Texas
Here are five other major hospital players in the state not listed above. They are listed in descending order by number of beds.

Methodist Hospital (San Antonio)

69. Methodist Hospital is the flagship hospital of the Methodist Healthcare based in San Antonio. Methodist Hospital first opened in 1963 and has 1,887 licensed beds.

70. Gay Nord became CEO of Methodist hospital in 2011. She is known for her hands-on leadership and her dedication to improving patient care. She previously served as CEO of Overland Park (Kan.) Regional Medical Center.  

71. Methodist Hospital is ranked the second best hospital in San Antonio and in the top 15 best hospitals in Texas in the US News Best Hospital rankings.

Ben Taub General Hospital (Houston)

72. Ben Taub General Hospital of Houston-based Harris Health System is home to 975 licensed beds (data for this facility includes information from the Lyndon B. Johnson General Hospital and the Quentin Mease Community Hospital) and the well-known Level I Ginni and Richard Mithoff Trauma Center.

73. Ben Taub General Hospital is also certified by The Joint Commission as a Primary Stroke Center.

74. Ben Taub General Hospital is staffed by physician faculty and residents of the Baylor College of Medicine.

75. George Masi was recently named interim president and CEO of Harris Health System. He had been the vice president and COO for Harris Health System since 2005

76. In February, Ben Taub Hospital refunded more than $876,000 to Medicare after an audit from the U.S. Department of Health and Human Services' Office of Inspector General found the hospital had incorrectly billed for outpatient dental services.

Parkland Memorial Hospital (Dallas)

77. Founded in 1894, Parkland Hospital serves the greater Dallas area with 968 licensed beds and is the primary teaching hospital for The University of Texas Southwestern Medical Center.

78. Frederick P. Cerise, MD, was named CEO of Parkland Health and Hospital System in March. Prior to his position at Parkland, Dr. Cerise served as associate dean for clinical affairs at the Louisiana State University Health Services Center, New Orleans School of Medicine.

79. Parkland Health and Hospital System announced the construction of a new $1.3 billion Parkland hospital campus in Dallas. The new facility will consist of 865 new beds and 23 new operating rooms. The facility is scheduled to open in May 2015.

80. In November 2013, an audit from the HHS' Office of Inspector General found Parkland Memorial Hospital had improperly received $743,582 in Medicare payments due to erroneous hospital outpatient dental services. Of the 100 claims examined, 98 did not comply with Medicare coverage requirements.

81. In 2012 and into 2013, Parkland Memorial Hospital faced a string of quality and safety violations resulting in CMS requiring Parkland to meet certain safety mandates. Although the safety mandates were met and Parkland Memorial Hospital kept its federal funding, Parkland faced penalties including a $1 million fine in Sept. 2012. As a result, Parkland experienced a multitude of executive changes, Robert Smith replaced Thomas Royer, MD, as interim CEO, John Jay Shannon, MD, was replaced by Christopher Madden as interim CMO and John Dragovits resigned for a position at Anthelio and was replaced by Ted Shaw as CFO.

Saint Luke's Episcopal Hospital (Houston)

82. St. Luke's Episcopal Hospital opened in 1954 and is a nonprofit, tertiary teaching hospital located in the Texas Medical Center. St. Luke's Episcopal Hospital is licensed for 850 beds with physicians in 23 clinical services, covering more than 40 specialties.

83. Joining St. Luke's in 2009, Margaret M. Van Bree, PhD, is the CEO of St. Luke's Episcopal Hospital and senior vice president of St. Luke's Episcopal Health System. Prior to her position at St. Luke's Episcopal Hospital, Dr. Van Bree served as senior vice president and COO of the University of Wisconsin Hospital and Clinics in Madison.  

84. St. Luke's Episcopal Hospital is nationally ranked in three adult specialties and ranked the third best hospital in Texas by US News.

Other notable healthcare players in Texas
Texas is also home to a wide range of healthcare providers, including several noteworthy specialty clinics. The following are leading clinics in the state not previously mentioned.

Texas Back Institute (Plano, Texas)

85. Texas Back Institute is one of the largest free-standing spine specialty clinics in the United States, offering a range of services to treat back and neck pain. The Institute's team is made up of more than 150 physicians and staff. The Texas Back Institute began in 1977 as a partnership with Stephen Hochschuler, MD, and Ralph Rashbaum, MD. Their joint vision for the institute was to create "an integrated multispecialty spinal clinic that included prevention, conservative care, surgical care, rehabilitation and research and development." The center is heralded as one of the premier organizations for spine healthcare, becoming the first institution in the United States to prescribe outpatient myelography and the first to lead an FDA study of the artificial disc and artificial disc replacement.

SpineCARE (Irving, Texas)

86. SpineCARE is a comprehensive spine practicing including 10 clinics throughout the Metroplex and is an affiliate of Lumin Health. Founded by Douglas Won, MD, SpineCARE is also associated with the new Star Medical Center, a new surgical hospital in Plano Texas focused on orthopedics and sports medicine care.

ACOs in Texas
ACOS have become increasingly popular with the switch from fee-for-service to pay-for-performance. As a result, the number of both commercial ACOs and Medicare Shared Saving Program ACOs continues to grow. ACOs in Texas that were not previously mentioned are listed below.

 87. Accountable Care Coalition of Texas, Inc. (Houston) The Accountable Care Coalition of Texas is comprised of independent physician associations, medical groups and health systems in the Houston and Beaumont areas of Texas, along with Collaborative Health Systems. The ACO is participating in the Medicare Shared Savings Program and covers approximately 70,000 Medicare beneficiaries.

88. Essential Care Partners, LLC (Austin, Texas) Essential Care Partners is an ACO bringing together 14 health centers across 83 locations in Texas. It began participating in the Medicare Shared Savings Program in 2012.

89. Physicians ACO, LLC (Houston) Physicians ACO covers the Houston and greater Dallas/Ft. Worth metropolitan area. The ACO began participating in the Medicare Shared Savings Program July 1.

90. RGV ACO Health Providers, LLC (Donna, Texas) Comprised of six primary care group practices, the RGV ACO serves patients from six Texas counties and their surrounding communities covering much of South Texas. RGV ACO began participating in the Medicare Shared Savings Program in 2012, and covers more than 6,000 Medicare beneficiaries.

91. Texoma ACO, LLC (Witchita Falls, Texas) Texoma ACO began participating in the Medicare Shared Savings Program July 2012. The ACO, comprised of the Clinics of North Texas, covers over 6,000 patients.  

ASCs in Texas
In Texas, ASCs employ over 7,300 people and have an estimated economic impact of nearly $1.7 billion, according to the Texas Ambulatory Surgery Center Society.

92. The Texas Ambulatory Surgical Center Licensing Act was enacted in 1985 requiring all ASCs in Texas to acquire a state license. Accreditation, however, is optional. The Facility Licensing Group develops rules establishing minimum standards for ASC licensing procedures and has the power to grant, deny, suspend and revoke a license. ASCs are also required to submit an annual report to the Texas Department of State Health Services.

93. According to the Texas Department of State Health Services, there are 434 licensed ambulatory surgery centers in Texas. Comparatively, California and New York, which have similar populations, have 754 and 116 ASCs respectively.

94. The Texas Ambulatory Surgery Center Society is a member-supported group providing state and federal legislative and regulatory advocacy for Texas surgery centers. An active member in both state and federal legislation and regulations, The Texas Ambulatory Surgery Center Society serves as a leading public policy advocate for ASCs in the industry.

Major ASC players in Texas
The following include some of the most recognized surgery center companies and leaders in the state of Texas.

95. Joe Zasa is the co-founder and managing partner of ASD Management, a privately held and funded surgery center company in the U.S with main offices in Dallas and Los Angeles. Mr. Zasa is the former president of the Texas Ambulatory Surgery Center Society. Leading a team of nursing, reimbursement, operations and facility management specialists, Mr. Zasa focuses on hospital/physician joint ventures in addition to development and turnaround strategies for existing ASCs.

96. United Surgical Partners International is a leading partner in surgical facility networks all over the country. Headquartered in Addison, Texas, USPI owns and operates 215 facilities, both ASCs and surgical hospitals, 148 of which are joint ventures with not-for-profit health systems. USPI has 63 partnerships and affiliations with surgery centers across its home state. This year, USPI reported a 20 percent increase in consolidated net revenues for the second quarter totaling $155.2 million, up from $129.2 million in the second quarter of 2013. Also in the second quarter of 2014, USPI also acquired a facility in Houston in partnership with Memorial Hermann Healthcare System.

Other health status issues for the state
The following are other current health status issues in Texas.

97. According to the Texas Medical Association, 82 percent of state physicians reported in the past two years that there were physician-owned specialty hospitals, surgical center or imaging centers in their area. Furthermore, the Texas Physician Hospital Advocacy Center has over 90 member hospitals in Texas — the most in the country.

98. As of February 2013, 207,500 additional Texans had obtained coverage through the federal insurance marketplace after the PPACA was put in place. According to the Houston Public Media, one million Texans remain uninsured.

99. Gov. Perry compared Medicaid expansion under the Patient Protection and Affordable Care Act to "putting 1,000 more people on the Titanic when you knew what was going to happen." Unsurprisingly, Texas is not currently expanding Medicaid.

100. A study released by the Federation for American Immigration Reform finds that providing education, healthcare, law enforcement, and social and government services to illegal aliens and their dependents costs Texas taxpayers $12.1 billion a year. Furthermore, the immigrant surge is quickly becoming a medical crisis. Many physicians providing medical care for illegal immigrants are saying that conditions of the immigrant population — including undocumented children in detention centers and those being released by U.S. Border Patrol ahead of their court dates — pose a high risk for infectious disease outbreaks.

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