The Texas Tribune reports:

At campaign stops and in the three debates he’s participated in so far, Republican presidential hopeful Gov. Rick Perry has made a sport out of bashing former Massachusetts Gov. Mitt Romney’s 2006 state health insurance plan. He’s missed no chance to yoke “Romneycare” to “Obamacare,” the federal health-care reform Republicans largely revile.

But while Perry condemns both efforts to make carrying health insurance mandatory, his home state of Texas faces a staggering crisis in health coverage: Texas leads the nation in the size of its uninsured population, has the third-lowest percentage of people covered by their employers and spends less per capita on Medicaid, the joint state-federal insurance program for the disabled and poor children, than all but one other state.

About 25 percent of Texans lack health insurance. Presumably, Perry doesn’t consider this acceptable. As the Tribune notes, “Perry’s office says the governor has gone to great lengths to help Texans get insured through the free market, without the ‘misguided approach’ of forcing them to purchase coverage. His aides did not offer a number for how many Texans have obtained health insurance due to his efforts, saying many of the initiatives were relatively new.”

I recently sought an explanation from the Texas Public Policy Foundation, a conservative think tank that is the recipient of the copyright on Perry’s book “Fed Up!” A number of top Perry donors and supporters are on the group’s board.

Spencer Harris, one of the foundation’s billed experts on health-care policy, is not the typical think tank guru. (He has no advanced degree, and his sole work experience prior to the foundation seems to have been working for a Republican state legislator.) I figured this would be the most pro-Perry justification I could find. However, the response to my inquiry was less than impressive. He insisted in a series of e-mail exchanges that a large number of the uninsured are illegal aliens. (He cites 1.7 million illegal aliens in the state, but it’s not clear how many of the 6.3 million uninsured are illegal immigrants.) He also told me that 1.2 million Texans would be covered by but haven’t signed up for Medicaid or CHIP [Children’s Health Insurance Program]. He claims there are many Texans uninsured by choice.

However, these answers don’t fully explain the extent of the problem or the governor’s efforts. Only recently did the governor launch an effective initiative to get more of those eligible to sign up for health care for which they are already qualified. Moreover, Texas has more stringent requirements for Medicaid than other states, making the task of getting insurance harder in that state than elsewhere.

While Harris said that more than 442,000 uninsured Texans are making more than $100,000, he conceded that of the uninsured, over 92 percent make less than $100,000 per year. That would suggest the voluntarily uninsured may not be such a significant factor. And finally, if all 1.7 million illegal aliens are uninsured, that would still leave Texas as the third-worst state in terms of percentage of insured residents.

The truth of the matter is that Perry’s efforts have been minimal or ineffective. Perry argued in his first debate that Texas was hampered by Medicaid rules that make coverage too expensive. That may be true, but other states (49 of them, actually) seem to have found better ways of expanding coverage. If Perry wants to point to the “Texas model,” it seems he needs to explain the trade-offs and choices he has made on health care and education. It’s fair for his opponents and voters to ask: If Texas is an economic model, why are its health-care and education systems not producing better results?