In the state of Texas, 25% of the residents do not have health insurance coverage, the highest rate of uninsured in the nation. The recent Supreme Court decision was not a partisan win or loss in the state, as it was in Washington. Although most likely those who did not have insurance had the most at stake, the ruling just caused more uncertainty in the lives of many in the state, who are already drowning in financial pressure and mounting medical needs.

Uncertainty intensified due to many unanswered questions over the efforts of the sate to fight the Medicaid expansion, the government insurance program for sick and low-income people. Increasing the coverage of Medicaid was the largest part of the health care legislation that the High Court restricted in this week’s ruling. The Court gave states the flexibility of opting out of the increase in Medicaid coverage without facing any penalties.

The Texas Health and Human Services commissioner Thomas Suehs said he was concerned that expanding the reach of Medicaid without first reforming it, would multiply the cost put on the state by the program. He also said that Medicaid already ate up over a quarter of the state’s budget.

Therefore, many of the people who are uninsured on the state, who would become eligible under coverage from the expansion, remain uncertain about the future. Over one million people in the Houston area, including surrounding communities do not have insurance. Though some of those are illegal immigrants, many others are U.S. citizens with full time mortgages and little or no work. Some work where healthcare is not offered by their employer or they cannot pay for private insurance. Others who are already eligible are not enrolled.