For a future discussion of federalism, and especially the relationship that the national government can forge with local governments - by passing the states, comes a story from the Washington Post on how some Texas counties are looking to go along with the national governments efforts to expand Medicaid by going around the state. 
Governor Perry has vowed to not expand the program. 
From the WP:
Local officials in 
Texas are discussing whether to band together to expand Medicaid 
coverage in some of the state’s biggest counties, making an end run 
around Gov. Rick Perry’s opposition to the expanded program included in 
President Obama’s health-care law.
For years, Texas’s six most populous counties, as well as some 
smaller localities, have offered free or low-cost health care for 
uninsured residents with incomes as much as three times the federal 
poverty level, or about $57,000 for a family of three. The cost of the 
programs: about $2 billion a year.
George
 Hernandez Jr., CEO of University Health System in San Antonio, came up 
with the idea of the alternative, county-run Medicaid expansion, and 
said he has been discussing it with other officials in his county, 
Bexar. “They are all willing,” he said. He added that he has also been 
talking up the proposal with officials in other big counties, such as 
those including Houston and Dallas, and is optimistic they’ll support 
the idea.
Robert Earley, CEO of JPS Health Network, the public 
hospital system serving Tarrant County, which includes the Fort Worth 
area, said he could see the idea catching on. 
- Click here for Fact Checker info on Medicaid.
- Wikipedia: Medicaid.
- Texas Medicaid Program.