Obama to Promote Health Act in Texas, Its Biggest Doubter WASHINGTON - President Obama on Wednesday travels to Texas, the largest of the Republican-led states that refuse to participate in his Affordable Care Act, to highlight the efforts of local groups and volunteers who are trying to make the law work for an estimated 2.5 million uninsured state residents. In remarks planned for this afternoon in Dallas, at Temple Emanu-El, Mr. Obama will be "calling on folks in Texas to join conservative governors in other states like Ohio and in Michigan, in Arizona, to put politics aside and not deny people health care out of ideology or politics," said David M. Simas, a White House adviser. About half the states have left it to the federal government to set up insurance exchanges, or marketplaces, where people can shop for coverage plans, and have also refused federal funds to expand Medicaid to more citizens. Among the most adamant in rejecting the law has been Gov. Rick Perry of Texas, a Republican who is considering a second campaign for president. Mr. Perry and Republican state legislators, who call the law an unworkable, big-government intrusion, have defied pressure from chambers of commerce, hospital and doctor groups, and nonprofit and community organizations in the state. Texas has several cities and rural areas that have among the highest concentrations of uninsured people in the nation, according to the nonpartisan Kaiser Family Foundation. Kaiser and the Urban Institute, a Washington policy research organization, estimate that nearly 2.5 million more Texans could be insured through the marketplaces by 2016, or just over one-third of a projected uninsured population that will exceed 7 million. And if Texas were to expand Medicaid as the Affordable Care Act provides, and accept the federal funds, another 1.2 million people would qualify for coverage, reducing the state's uninsured population by more than half, the groups say. That increased coverage would reduce the costs to Texas communities for uncompensated medical care - from uninsured residents leaving hospitals, emergency rooms and clinics with their bills - by $1.7 billion over a decade, and generate other economic benefits for the health care industry and local communities, according to Kaiser. Mr. Obama, like several administration officials before him, intends by his trip to Dallas to herald the efforts of local business, religious and community groups that have stepped into the void to help residents find affordable coverage, and determine if the applicants qualify for federal tax credits to defray costs. At Temple Emanu-El, he will meet with volunteers and trained "navigators" who are working through Dallas Area Interfaith, a coalition of several dozen churches and schools, to help people learn about the law. The organization compiled a booklet and circulated 100,000 copies in religious congregations, schools and community centers, said Willie Bennett, lead organizer for Dallas Area Interfaith. Gwen Lummus, chairwoman of the group's health care committee, said training sessions had attracted more than 200 volunteers, who in turn have held seminars that drew 1,600 people. "It's sort of all been left up to community groups to get the word out about this because there's no formal education program or anything that the state is doing," Ms. Lummus said. For such local groups, the technological problems with the federal healthcare.gov website since Oct. 1, when enrollment in the state-based marketplaces began, are only part of the challenge - and perhaps the easiest to overcome. "For the first time last Thursday and Friday, we were able to go completely through the website with people who were dealing with our counselors at Parkland Hospital and get them to pick a plan and get to the point where all they needed to do was send in their check," said Clay Jenkins, the Dallas County judge. That can be hit or miss, but it continues to improve regularly. "This was going to be a monumental challenge in Texas anyway," Mr. Jenkins said. It's critically important that we step into the gap created by the state's unwillingness to work with the feds on this to find some solution. More than one-quarter of Dallas County residents, or about 670,000, are uninsured, and unpaid medical bills are the county's biggest and fastest-growing cost, Mr. Jenkins said. He and other state officials say they are still hoping that Republican state officials will reach some compromise with the Obama administration to expand Medicaid in Texas, as neighboring Arkansas has done. Mr. Jenkins has met with Mr. Obama and his top health officials, including Kathleen Sebelius, the secretary of health and human services, and said, "It's very clear to me that they are more than willing to work with Texas and to craft a plan that incorporates the state leaders" values." He said: "Our state that prides itself on rugged individualism and self-reliance says we don't want to participate in a program that would allow people who currently can't afford health coverage to purchase their own health coverage. We would rather them go to county hospitals in places like Dallas and have the taxpayers pay the full cost of their inefficient and expensive care. That really makes no sense.  "Our local citizens are sending their federal taxes to pay for other states that made the good decision to accept federal dollars," he added, "and then we're turning around and paying county hospital taxes, higher insurance premiums and higher emergency room and other costs."