The state with the country’s worst health care record just happens to have a governor who has been the loudest voice against national efforts to improve it.

A quarter of the residents of Texas, 6.3 million people, are uninsured, by far the highest percentage in the country. (That number includes more than a million children.) Texas ranks last in prenatal care and finished last on a new federal assessment of overall health quality that examined factors like disease prevention, deaths from illnesses, and cancer treatment.

Yet Gov. Rick Perry — strangely puffed up as he was so often in his presidential bid — recently told the Obama administration that he would proudly refuse a huge infusion of Medicaid money that would significantly reduce those shameful statistics and cover 1.7 million more people. The same indifference to suffering that pushed Texas to the bottom is now threatening to keep it there.

At least five other Republican governors have made a similar choice, announcing that they will not expand their Medicaid program for the poor even though the federal government would pay for almost all of it for several years under President Obama’s health care reform law.