(CBS News) AUSTIN, Texas, - Some states with budget problems are opting out of participating the president's health care law and the cost that is associated with it. Among them is Texas, where 6 million residents who don't have health insurance.
More than half the patients of the Los Barrios Unidos health clinic in Dallas are uninsured. Nearly a third are on Medicaid -- the federally sponsored insurance program for the poor.
Dr. Susan Briner runs the clinic. Of those who come to the facility, Briner replies: "The people without health insurance in Texas are the people who work at low-paying jobs ... the people who work by the hour, who work in restaurants, who work in yards, who work in daycares."
Two million more low income Texans would be covered by the Medicaid expansion prescribed by the Affordable Care Act. But Texas is refusing to participate, joining Wisconsin, Florida and Louisiana.
Texas would be eligible for $164 billion in federal aid to pay for the expansion through 2020. But Lt. Gov. David Dewhurst says Texas' share of $27 billion would be a heavy burden.
"Quite frankly," he said, "the Medicaid system is broken and by simply adding a million and a half to two million more people to Medicaid will not solve the problem."
Texas will also be the largest state to refuse to create the state-run health care exchanges that would allow people to shop for affordable coverage. In a letter to the Obama administration, Texas Gov. Rick Perry called the requirements "brazen intrusions into the sovereignty of our state."
"It doesn't materially improve the health care of Texans and Americans," said Dewhurst. "And in five short years it will start to bankrupt the state of Texas and other states."
Opting out will not stop health care exchanges from being set up in Texas. If the state doesn't do it, federal authorities will.
Now Texas leaders were betting that the Supreme Court would likely strike down the health care law, so they've done little to prepare for the exchanges that must be set up by 2014. A provision in the health care law does specify that even federal authorities do set up the exchanges, Texas could petition to take over those exchanges eventually at some point if they chose to.