Investor services and credit rating agency Moody’s has some news for GOP governors hesitant to expand their state Medicaid programs under Obamacare: either hospitals in states refusing the expansion, or the states themselves, will feel pressure on their credit ratings due to higher uncompensated care costs and cash-strapped budgets.

In a press release regarding a new Moody’s report on Medicaid expansion, the agency explains that refusing the expansion would by necessity force one of these institutions or the other to lose out — since the resulting increase in the ranks of uninsured, low-income Americans would put fiscal strains on safety net hospitals or the state at large. As Nicole Johnson, a Senior Vice President at Moody’s, explained, “States that opt out of Medicaid expansion will have to choose whether to compensate for the shortfalls with their own funds or leave hospitals to absorb the costs, which will increase rating pressure on the hospitals. States that choose to fund uncompensated care costs themselves could face budgetary strain.”

As the press release notes, refusing to expand Medicaid would significantly increase uncompensated care costs for hospitals that cater to low-income Americans because Obamacare institutes deep cuts to reimbursements made to these “disproportionate share hospitals,” or DSHs. This is because lawmakers originally expected the expansion to be mandatory for all states, thus lowering the need for DSH payments — but the Supreme Court ruled that provision to be optional, instead.

Moody’s has consistently argued that Obamacare is a good deal for hospitals and states. In fact, before the Supreme Court had issued its ruling on Obamacare, Moody’s released a statement saying that “the best possible outcome from the Supreme Court would be a full confirmation of the law” because that would be “credit neutral.” They also warned that possible hits to credit ratings would not just be limited to safety net hospitals, because, “With fewer people covered by healthcare insurance, for-profit hospitals will face increased bad-debt exposure and reduced reimbursement rates.”

Now, in their latest report, the agency asserts that the negative effects of refusing to expand Medicaid “will be greatest in states that opt out of Medicaid expansion, but have a relatively high proportion of uninsured residents.” That describes many states led by GOP governors, who have recently been coming to embrace the expansion after intense lobbying by advocates for the poor and hospital associations that are concerned about these very uncompensated care costs. But many of these GOP governors face an uphill battle against members of their own party when it comes to expanding Medicaid.

Senate Minority Leader Mitch McConnell repeated the siren call that Republicans are not going to give up on repealing Obamacare.

But in the same speech at the Conservative Political Action Conference, McConnell admitted there is little plausibility to the idea, since Republicans have already lost. “When it came to Obamacare, we gave it everything we have, everything we have, and we just lost.”

McConnell explained that won’t stop Republicans, in a speech where he assured his audience that the GOP is not stuck in the past:

This law is a disaster. Anyone who thinks we’ve moved beyond it is dead wrong. Obamacare should be repealed root and branch. We’re not backing down from this fight.

“It may not seem like it now,” McConnell concluded, “but we’re actually winning.”

Republicans are not, in fact, winning. After more than 30 votes in Congress, a Supreme Court challenge, and a presidential campaign failed to repeal the health reform law, even House Speaker John Boehner admitted “Obamacare is the law of the land.”

But many Republicans haven’t accepted that reality. Boehner’s admission earned backlash from his party, while Paul Ryan’s latest House Republican budget still assumes repeal of the law. And Tea Party favorites in the Senate still occasionally threaten to shut down the government unless Obamacare is defunded.

Earlier this month, scientists reported that they may have “functionally cured” a two-and-a-half year old child of her HIV infection by treating her with aggressive rounds of drugs as soon as she was born. They weren’t sure what that meant for adults living with HIV, since doctors may have simply prevented the transmission of the virus rather than eliminating an existing infection. But a new study suggests the same method may also work for individuals who contract HIV infections later in life.

French researchers are reporting that 14 adults have been “functionally cured” of their infections after undergoing initial treatment for HIV. The adults — just as the baby girl who was the subject of the earlier study — were aggressively treated with HIV drugs during the first two months of their infections. Now their infections are under control, and the ten men and four women in the group haven’t needed to take any HIV drugs for between four and 10 years. HIV-positive individuals are typically unable to stop undergoing HIV treatment without experiencing a “sharp and dangerous” increases in HIV replication.

Asier Sáez-Cirión, who helped analyze the findings at the Institut Pasteur in Paris, told MedPage Today that the study’s results suggest that early treatment may have some hope of “curing” HIV infections:

Although the phenomenon may not have immediate clinical implications, he said, it’s “proof of concept” that the immune system can control HIV in some circumstances.

It may also offer hope for a vaccine, he said. “It shows there is some immune response,” he said, “that can be stimulated not just to control infection but to prevent infection if that part of the immune system can be primed and activated.”

Indeed, the researchers argued that study of these patients and others like them could “open up new therapeutic perspectives” for people with HIV.

To be clear, scientists don’t know if these cases of “functional cures” will have broader implications for the 34 million people living with HIV around the world. As Sáez-Cirión points out, additional scientific research is needed to assess whether the phenomenon can be replicated on a wider scale. But it may help direct public health advocates’ energy toward effective methods of combating the virus in the very early stages of infection, and it also highlights the importance of regular testing so that newly infected individuals can become aware of their HIV status before going too long without treatment.

Here in the U.S., the CDC is focusing its efforts on expanding access to affordable HIV testing, particularly in the low-income urban areas where the virus tends to be most highly concentrated — but there’s still more work to be done, considering that about a quarter of the HIV-positive Americans aren’t aware they have the virus. Fortunately, HIV testing will be covered under Obamacare.