When you don't have much money, you have to prioritize, and that is a key issue that the wealthy elites who set off on insurance reform forgot to factor in. Massachusetts, which the Federal government claimed was a model for its Affordable Care Act, now has to spend 40 percent of its budget so that 25 percent of people can have even basic health care. That is not sustainable.

In other states that won't teeter on the edge of bankruptcy to fund health care, things are bleak for other reasons. In Texas, people would rather the IRS seize their bank accounts in the future than have to pay for insurance they don't want now. Almost 70 percent of uninsured Texans said the high cost of health insurance is the reason they remain uninsured, according to a new report by Rice University's Baker Institute for Public Policy and the Episcopal Health Foundation.  About 20 percent of adult Texans still don't have health insurance.

Of those, less than 20 percent, so 4 percent of adult Texans, simply don't want health insurance.

"An important finding of this survey is there's no significant information barrier for Texans who still don't have health insurance," said Elena Marks, EHF's president and CEO and a nonresident health-policy fellow at the Baker Institute. "Just two years ago, it was a much different story. As the Affordable Care Act (ACA) coverage options went into effect, lack of information about the law and the new health insurance options was widespread."

The government clearly needs to spend less money subsidizing drives to get enrollment up and score political points and more on getting the costs down. No one needs more 'awareness' about ACA health insurance marketplace plans at this point.

The Health Reform Monitoring Survey (HRMS) is a quarterly survey of adults ages 18-64 that began in 2013. This report is a summary of data extracted from the HRMS surveys in Texas administered between September 2013 and September 2015.