PERMIAN BASIN - There are more than 49 million uninsured Americans.
In Texas, there are more than 6 million, 25% of the state.
What upholding this mandate means for West Texans is that if they don't have health insurance by 2014, they'll pay a penalty in the form of a tax.
Medical Center Hospital CEO, Bill Webster, said the Affordable Care Act leaves less uninsured people in the Basin but he worries they could be under-insured, as he predicts many of them will be picked up by struggling Medicaid.
"Medicaid, in this biennium, is probably $4-5 billion under funded in this current biennium and that's only going to grow," Webster said.
The federal government is leaving it up to the states on how to expand their Medicaid and Webster wonders if there will be enough to go around with our booming population.
"We already have a fairly low physician-to-population ratio," he said. "If you add population growth on top of that and more people with insurance, with access, I do think you'll see some access issues."
For some West Texans, the Act has helped get them insurance when they couldn't afford it.
"The older I've gotten, I can't afford the premiums and I have a year yet before I'm eligible for Medicare so yes I was very relieved," Odessa resident, Louis Ormand, said.
Others see it as a violation of their right to choose and to not be taxed more.
"We fought a revolution over being over-taxed and that's what we are," Odessa resident, Dixie Sletten, said. "We're over-taxed, over-burdened with taxes."
"Government should not force us to do anything," said Odessa resident, Aurora Castillo. "It's our own rights to do what we want to do."
MCH has now become the anchor hospital to develop a regional health plan.
That region includes Midland and hospitals from both cities will now work together to figure out how to expand their Medicaid programs and how best to make sure everyone in the Basin gets enough insurance.
They'll have that plan sent off to the Texas Department of State Health Services within the next two months and it'll be in place by September.