DALLAS - It's a defining moment for the future of health care in our country, and sets up a show down between Texas Republicans, Governor Rick Perry and the President of the United States.
There's a big, costly political choice left by the Supreme Court that could undercut the effort to insure more people in Texas.
Texas was among 27 states that challenged the part of the law that required states to expand Medicaid coverage to the working poor or risk losing all federal Medicaid money.
But the court struck that down.
If the Medicaid mandate were upheld, 1.5-million uninsured adults and nearly 600,000 children would've been added to Texas Medicaid rolls, according the Center for Public Policy Priorities.
But now the legislature and governor must choose whether to take the offer.
"It does mean Texas now has the option -- the choice -- where it can make it's own decision whether or not to expand it's Medicaid program, or to abide by the current limits on Medicaid," said Texas Attorney General Greg Abbott.
In a Fox News appearance, Governor Perry wasn't asked and didn't say if he wants Medicaid expanded, just that he didn't like the tax penalty the court upheld for declining coverage.
"That offer is, 'You're going to buy my insurance, and if you don't, I'm going to tax you," Perry said.
Texas House Speaker Joe Straus said in a statement, "The Texas House will do its part during the next session by attempting to limit any negative impact the law might have on our state.”
But the Texas Dept. of Health and Human Services, which oversees Medicaid, said it's pleased the state can push back since the program is about one-fourth of the state budget, with higher costs ahead.
But the federal government would cover costs the first three years and pay $9 of every $10 in the program after that.
Democrats, such as Dallas State Rep. Rafael Anchia, say lawmakers would be foolish to turn that down.
"I have a feeling that the legislature is going to do the right thing here, and expand coverage for those very needy Texans who need the health insurance," Anchia said.
The ruling did uphold starting an exchange in Texas where people not qualifying for Medicaid and who don't get insurance on the job can buy coverage. For example, families of four earning about $31,000-to-$92,000 a year can qualify for sliding government subsidies to purchase insurance.
Houston State Rep. Garnet Coleman is one of the leading Democrats in Texas on the health care law.
"Those individuals will have the opportunity now to have health insurance subsidized to where they can afford it," Coleman said. "That's what's really important, because we're talking about middle-income families at the lower end of the range."
He estimates the total uninsured in Texas could drop from six million to two million in 10 years.
Much is still unclear, but what's certain is the law will move ahead in Texas.
Regarding more court challenges, Abbott said, "We'll have to see the way that the Obama administration continues to implement this law, about whether or not there are any future legal challenges that can be waged. We will continue to evaluate our legal options going forward."
But Democrat Anchia said in response, "The last thing we need is more frivolous lawsuits. The entirety of the Affordable Care Act has been upheld as constitutional by the Supreme Court of the United States. There's no where else to go on this."