(Bloomberg) — Randy Osban’s job selling ribs and brisket from a yellow trailer on Texas’s state road 71 offers a sweeping view of the hill country beyond Austin. One benefit his business doesn’t provide is health insurance.

Osban, 55, could use it now, as his wife Kathy, 59, has a heart condition and the money he makes barely covers current expenses, much less a hospital bill. While he’s heard of ‘Obamacare,’ he doesn’t know if it can help him or how to enroll.

“I’m in the dark; total darkness,” Osban said.

In 15 days, Americans will start signing up for medical coverage through the Affordable Care Act’s online exchanges. The law, targeting most of the 50 million uninsured, promises to change the way health care is provided in the U.S. It forces most Americans to buy coverage, offers subsidies to pay for it, mandates insurer outlays for disease prevention and guarantees a pre-existing condition won’t get you turned down.

You wouldn’t know it in Texas.

Distrustful of the U.S. government, with a defiant and independent heritage, Texans are largely unsupportive of a law they little understand. While no state has a higher proportion of uninsured, the Republican governor, Rick Perry, has refused to help build or promote an insurance exchange in the state and he won’t expand Medicaid, the joint state-federal health plan for the poor, to care for more people.

“It’s still Texas and it’s still, ‘pull yourself up by your own bootstraps,’” said Jim Young, who runs a private health program for the uninsured in San Antonio. The attitude is “if someone can’t do that, it’s their own problem. It’s a holdover from the Old West.”

Cruz’s fight

More than 6 million Texans who now lack insurance coverage may be eligible to purchase it through a U.S.-run exchange that will open on Oct. 1, according to the nonprofit Kaiser Family Foundation. Yet Texas has provided no help to groups working to educate residents on the exchange, says Keilah Jacque, a policy coordinator at City Square, a social service agency in Dallas.

Instead, the state’s top officials and representatives are focused on getting the law overturned. U.S. Senator Ted Cruz, a Republican pushing a plan to defund the ACA in Congress, appeared Aug. 20 at a rally against the law in Dallas.

Organized by Heritage Action for America, the “Defund Obamacare” event drew more than 1,500 people to a hotel ballroom, a crowd that leaned elderly and white and treated Cruz like a folk hero.

Cruz’s speech largely focused on politics, until a woman stood up and challenged him, asking what he would do for the 6 million Texans “that can’t afford health care.”

Self sufficiency

“We can take care of ourselves!” a man in the crowd shouted at her, to applause.

Cruz thanked the woman.

“I think we need to reform our health care to make health care more accessible, reduce the cost of health care and empower patients,” he said. “I’ve gotta tell you, ‘Obamacare’ is making it worse.”

Perry, meanwhile, has swatted away efforts by U.S. Health and Human Services Secretary Kathleen Sebelius to publicize the law in trips she’s made this year to Dallas, Austin, San Antonio and Houston. The governor has greeted Sebelius’s arrival with critical press releases.

“Texans are already subject to too much costly and burdensome federal regulation, and Obamacare only makes the problem worse,” Perry wrote in statement released while Sebelius was visiting Houston.

Personal stakes

Combating this are activists such as Luis Veloz, a 19-year-old who works with the Texas Organizing Project, part of a nationwide informational drive being organized and run by Enroll America, a Washington-based nonprofit whose president previously worked on behalf of the Obama campaign and later held a position as an aide in the White House.

The Texas group, a network of 20,000 volunteers, had contacted more than 100,000 people with a month to go before signups begin, says Allison Brim, organizing director for the Texas Organizing Project.

For Veloz, the effort is personal.

His own family is uninsured and facing about $200,000 in medical bills after his father suffered a heart attack in November, Veloz said over lunch at a Dallas Tex-Mex restaurant. He spends his evenings knocking on doors in neighborhoods with high numbers of uninsured and accosting Texans on the street to educate them on the law, he said.

“It’s my fight,” he said. “The more people sign up, the better it’s going to work out for my family.”

Obama supporters

Veloz said he measures his progress through the telephone numbers he collects from people who want more information on the law and those he will check in with later to see if they’re enrolled through the exchanges and offer them his help. He was escorted out of Cruz’s event after heckling the senator.

“While there may be some in Texas who want to make it more difficult for Americans to access affordable health insurance, we are fortunate to have a strong network of partners throughout the state who are committed to this effort,” says Joanne Peters, a spokeswoman for Sebelius. “We have a broad coalition of stakeholders who are working every day to provide Texans with accurate information about how they can get the coverage their family needs.”

Lucy Nashed, a spokeswoman for Perry, said the governor didn’t have time for an interview the week of Aug. 19.

The federal government is building an insurance exchange for Texas, a marketplace where people can choose plans on the Internet or by phone, or work with insurance brokers who will purchase coverage for them.

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