AUSTIN, Texas (November 24, 2012)—Texas Gov. Rick Perry has promised to fight against implementing the Affordable Care Act, but that doesn't mean big changes aren't coming to health care in the state, and it won't save lawmakers from facing tough spending decisions.

Texas has about 6 million uninsured residents, which is nearly a quarter of its population, higher than any other state.

For the 2014-205 budget cycle, the Texas Health and Human Services Commission that runs the Medicaid program has asked the Legislature for an additional $6.7 billion.

Republican leaders, meanwhile, have already pledged to increase the entire state budget by only $7 billion.

If they plan to maintain their spending cap, they would need to pare down spending on health care.