Texas already has the narrowest Medicaid eligibility standards and spends the second least of any state on health care for the poor per capita. But that hasn’t stopped Gov. Rick Perry from advocating that Texas to opt out of Medicaid altogether and receive less generous block grants that would allow it to institute even harsher limits to the program.

The three-term governor recently signed legislation that would effectively petition the government to block grant the Medicaid program , which the Obama administration will likely reject. But back in 2008, he tried his luck with President Bush. Perry’s request asked for two big things: authority to implement enrollment caps in Medicaid and additional federal dollars to establish a “Texas pool to help low-income people buy private insurance.”

The Bush administration denied the waiver, arguing that Perry’s Medicaid reforms were too restrictive. From the federal government’s August 7, 2008 letter to the Texas Health and Human Service Commission:

The proposal to include a benefit limit of $25,000 on the parents/caretaker relatives, is one that cannot exist under Medicaid for this group. In addition, there is no precedent under CMS-approved demonstrations to approve an annual benefit limit as low as $25,000 even for an expansion population.

The proposal did include several progressive elements. Texas sought to use additional federal dollars to provide premium assistance to children enrolled in the children’s health insurance program and infrastructure grants for community-based programs. Most interestingly, the state also requested authority to cover immigrant “children with family income below 200 percent” of the federal poverty line” who had not yet met the 5-year waiting period. In 2008, “federal law required a 5-year waiting period before many legal immigrants were permitted to enroll in Medicaid and CHIP, although many States offered health coverage to these populations with State-only funds.” President Obama lifted the 5-year ban in 2009.

Still, the fact that Texas’ Medicaid stinginess was ultimately rejected by the Bush administration — itself no fan of government health care — speaks volumes of Perry’s disinterest in covering the poorest Americans and explains his state’s high uninsurance rates.

Last week, the Department of Health and Human Services announced that the federal government would be awarding $28.8 million to 67 community health center programs across the country as a result of funding made available through the Affordable Care Act. “Community health centers work to improve the health of the nation’s underserved communities and vulnerable populations by ensuring access to comprehensive, culturally competent, quality primary health care services,” the agency said in its release, noting that the new grants will help deliver care “for an additional 286,000 patients.”

But Rep. Joe “You lie” Wilson (R-SC) has seized on the announcement as a fundraising opportunity, arguing that since the funds are distributed to health clinics in farm communities that don’t check the legal status of their patients, the health law will, in fact, subsidize care for undocumented immigrants. Wilson, in other words, is taking a victory lap and claiming that President Obama did lie about the provision:

Nearly two years ago I made national news when I voiced your outrage at the misrepresentations being perpetuated by the Obama administration. The media and Obama’s liberal allies attacked me for only pointing out the truth that ObamaCare would cover illegal immigrants.

Yesterday, my point was vindicated when the Department of Health and Human Services announced its newest ObamaCare grant. CNS News reported:

“Because the health care centers receiving $8.5 million in ObamaCare money ‘to target services to migrant and seasonal farm workers’ will not check the immigration status of the migrant workers who seek their services it is inevitable that they will serve illegal aliens.”

The president specifically promised the American people that ObamaCare would not cover those who are here illegally. He misled all of us.

Wilson’s self-congratulatory re-election gimmick is not only callous in its tone, but also highly dismissive of the health care needs of migrant workers — many of whom are actually legally working in the United States. According to data from the U.S. Department of Labor, since 2001, the share of crop workers who are citizens “has increased from about 21 percent to about 33 percent, while the share who hold green cards or other forms of work authorization has fallen from about 25 percent to about 19 percent.” The Department estimates that approximately half of all migrant are citizens or have another legal status.

In fact, most still have a hard time obtaining steady insurance through Medicaid and have to rely on community health centers for their primary care needs. “Different state eligibility requirements and the lack of portability or reciprocity in Medicaid and SCHIP, create administrative barriers to coverage for mobile populations,” the National Center for Farm Workers Health concludes. “Therefore, when farmworker families move from state to state seeking employment, Medicaid and SCHIP benefits stop at the state border, making Medicaid and SCHIP unobtainable for most farmworkers and their families.”

As HHS spokesperson Chris Stenrud told Fox News, “By statute, health centers are required to provide primary health care to all residents of the health center’s service area without regard for ability to pay. However, health centers do not provide free care. All health center patients are expected to contribute to the cost of their care.”

Community health centers offer primary care to underserved populations — both legal and undocumented. And if Wilson doesn’t buy the moral argument of ensuring that everyone should have access to medical treatment, he could at least take solace in the fact that these centers create jobs, lower health care costs by treating conditions before they grow chronic and keep people out of the emergency rooms. But even all that won’t shake his deep resistance to treating all people as human beings.

Rick Perry cited health data about the high risk of cervical cancer among young women when he defended his decision to mandate sixth-graders to receive the HPV vaccine in 2007, but some critics saw ulterior motives in the Texas governor’s order to make small-government Texas the first state in the nation to require vaccination. After all, Perry had not consulted Republicans in the legislator before issuing the requirement early that February and had expressed no prior interest in expanding access to women’s health care — or doing much of anything to improve public health in the state.

And so, Perry’s detractors turned to his relationship with the vaccine manufacturer, Merck — which stood to profit from the order — and the company’s stealth campaign to push states to adopt the requirement. From the Associated Press’ 2007 account:

Merck is bankrolling efforts to pass laws in state legislatures across the country mandating it Gardasil vaccine for girls as young as 11 or 12. It doubled its lobbying budget in Texas and has funneled money through Women in Government, an advocacy group made up of female state legislators around the country. [...]

Perry has several ties to Merck and Women in Government. One of the drug company’s three lobbyists in Texas is Mike Toomey, his former chief of staff. His current chief of staff’s mother-in-law, Texas Republican state Rep. Dianne White Delisi, is a state director for Women in Government. [...]

Perry also received $6,000 from Merck’s political action committee during his re-election campaign.

Shorty after Perry issued the order on Feb. 2, 2007, the AP reported that “Perry’s chief of staff had met with key aides about the vaccine on October 16, the same day Merck’s political action committee” donated to the governor. Still, Perry dismissed all charges of impropriety. “When a company comes to me and says we have a cure for cancer, for me not to say, ‘Please come into my office and let’s hear your story for the people of the state of Texas, for young ladies who are dying of cancer,’ would be the height of irresponsibility,” the Republican governor said. “Whether or not they contributed to my campaign, I would suggest to you, are some of those weeds that we are trying to cut our way through.”

What made matters worse, however, was that Merck had “made headlines in 2004 for failing to disclose that its painkiller Vioxx raised the risk of cardiac arrest and stroke in patients” and so critics worried that the company’s new HPV vaccination was yet untested and could suffer from defect.

The opposition proved overwhelming and Perry quickly backed down from his requirement, allowing the executive order to be overturned by the legislature (only three of 181 lawmakers voted against the bill rescinding the requirement). But he didn’t go quietly, chastising lawmakers in his own party for misrepresenting his motives and intentions. “In the next year, more than a thousand women will likely be diagnosed with this insidious yet mostly preventable disease,” said Perry. “I challenge legislators to look these women in the eyes and tell them, ‘We could have prevented this disease for your daughters and granddaughters, but we just didn’t have the gumption to address all the misguided and misleading political rhetoric.’”