DALLAS (AP) — U.S. Health and Human Services Secretary Kathleen Sebelius visited Texas for the fifth time in two months Thursday to tout the benefits of the federal health care overhaul, but she acknowledged that many poor, uninsured Texans will get no help without the cooperation of state Republicans who unyieldingly oppose the law.

Texas has the highest rate of uninsured people of any state in the country, but top state officials have refused tens of billions of dollars offered by the federal government to expand Medicaid.

Unless officials change their mind, people who would have gotten health coverage under Medicaid will be left out, Sebelius said after an event in Dallas. Her hope, she said, is that officials will change their mind once Medicaid funding begins elsewhere in January.

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