U.S. Health and Human Services Secretary Kathleen Sebelius, right, with Dallas Mayor Mike Rawlings, left, discusses the implementation of the federal health care overhaul in Dallas, Texas, on Thursday, September 26, 2013. Sebelius and Rawlings discussed the impending overhaul's importance to North Texas. (AP Photo/Nomaan Merchant)

DALLAS (AP) -- U.S. Health and Human Services Secretary Kathleen Sebelius visited Texas for the fifth time in two months Thursday to tout the benefits of the federal health care overhaul, but she acknowledged that many poor, uninsured Texans will get no help without the cooperation of state Republicans who unyieldingly oppose the law.

Texas has the highest rate of uninsured people of any state in the country, but top state officials have refused tens of billions of dollars offered by the federal government to expand Medicaid.

Unless officials change their mind, people who would have gotten health coverage under Medicaid will be left out, Sebelius said after an event in Dallas. Her hope, she said, is that officials will change their mind once Medicaid funding begins elsewhere in January.

Texans can still purchase health insurance in federal exchanges that open enrollment next week.

"The money starts to flow on January 1, 2014," Sebelius said. "That's when this federal deal would kick in. And every day, Texas would leave a portion of that money on the side of the road."

Top Texas Republicans continue to fight the Affordable Care Act three years after Congress passed it. Gov. Rick Perry says the overhaul is bad policy and the Medicaid expansion, even if it's mostly funded by Washington, would still hurt the state budget. The federal government will pay the full cost of new coverage until 2016, then phase down to 90 percent.

Perry has also asked the state insurance commissioner to adopt strict regulations for federal "navigators" trained to help people sign up for coverage.

Sebelius has touted the work of local officials and groups in Texas that are promoting the law. She went to Houston, Austin and San Antonio last month.

On Thursday, she sat next to Dallas County Judge Clay Jenkins and Dallas Mayor Mike Rawlings, both Democrats who said they would work hard to educate their residents and get them to enroll in exchanges.

About 500,000 people in Dallas County don't have health insurance, Rawlings said. He has challenged city council members to see who could sign up the most constituents. Dallas libraries and recreation centers will also distribute materials about the law.

"If that was happening with our drivers across this city, we would have a riot," Rawlings said. "This is a serious issue that we've all got to understand."

Jenkins compared the outreach work to last year's effort to fight mosquitoes amid a West Nile outbreak, joking about the sleep-deprived nature of the staff in both instances.

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