State hospital officials across the country have been speaking out in favor of the Obamacare provision that expands Medicaid coverage to an estimated 17 million low-income people across the country, urging their legislators to opt into the health care exchanges set up under the law. Despite the significant financial benefits for states that accept the expansion, some Republican governors have already threatened to reject it. In Missouri, health officials articulate the stark reality — struggling hospitals without enough funds that would eventually be forced to close their doors — that would be in store for their state if Gov. Jay Nixon (D-MO) does not accept the expansion.

The St. Louis Post-Dispatch reports that, if Missouri chooses to forgo the health insurance exchange under Obamacare, hospitals in the state could lose hundreds of millions in funding:

The projected loss of up to nearly $400 million would come from cuts to federal Disproportionate Share Hospital (DSH) payments, and at least one doctor has speculated the cuts could force some rural hospitals to close.

The cuts were to be eased by a Medicaid expansion that would add more than 300,000 Missourians to that program, but leaders in the Missouri House and Senate say they are likely to block that move.

“If you don’t expand Medicaid and you eliminate the DSH funding, you have the ability to significantly impact hospitals’ financials,” Missouri Hospital Association spokesman Dave Dillon said. “It’s extremely problematic.”

A professor of pediatrics in the Division of Neonatal-Perinatal Medicine at St. Louis University estimates that as many as 40 to 50 percent of rural hospitals in the state could close, if the expansion is not enacted and the funds from it are not replaced. In addition to rural hospitals, larger medical centers in St. Louis and Kansas City could also be hit with cuts.

Members of Congress have urged governors to “refuse to play politics with people’s health and publicly support expanding health care access to the thousands of people in your state who need it today.” Nonetheless, Republican governors in states including Florida, Mississippi, Texas, Wisconsin, South Carolina, and Louisiana have pledged to refuse the Medicaid expansion. Missouri’s own governor has not publicly taken a position yet.

Jefferson County, Alabama, is working its way out of a financial crisis — caused by corrupt politicians and a bad swap deal crafted by the mega-bank JP Morgan Chase — after declaring bankruptcy last year. To save money, county commissioners voted 3-2 in committee to end inpatient services in 30 days at Cooper Green Hospital, one of the state’s only facilities for indigent cares. Over the past three years, the nonprofit hospital has received $10 million from the county’s general fund, which one commissioner said officials “cannot afford” to keep doing.

County Commission President David Carrington said ending inpatient care would give the hospital more funding for other services. “I think there are alternate ways inpatient care can be provided in Jefferson County without the county running an inpatient hospital,” Carrington said. But when a state legislator proposed a bill last spring that would have forced the hospital to close, one researcher estimated that ending inpatient care at Cooper Green Hospital would increase costs at other area hospitals:

[C]losing the county’s financially troubled safety-net hospital, could drive up health care costs as Cooper Green’s disproportionate share of Medicaid and uninsured patients flock to other hospitals’ emergency rooms, according to Eric Ford, a public health professor at the University of North Carolina at Greensboro.

It could also lead to dramatic changes in the area’s overall health care system, he said.

“It won’t be good for either the customers or the organizations in the short term,” he said.

About 65 patients are in the hospital each day, and it is uncertain where they would go if Jefferson County commissioners vote next week to end inpatient services. And in April, Mark Wilson, CEO of the Jefferson County Health Department, said Cooper Green could be forced to close its emergency room, which treats about 36,000 people a year, if the hospital had to end its inpatient care.

While county officials threaten to endanger the local health care system, the state legislature has refused to reinstate the county’s occupational tax that could help officials avoid cutting an additional $40 million from the county budget.

Now that the Department of Health and Human Services has confirmed that Obamacare prohibits federally funded health care programs from discriminating against transgender people, Jay Kallio should finally be able to receive the cancer treatment he deserves.

Kallio, who transitioned from female to male at the age of 50 without undergoing gender reassignment surgery, repeatedly suffered a lower quality of care from medical professionals during a battle with breast cancer because his doctors treated his gender identity as a road block:

When a suspicious lump was found in his breast and tested positive for cancer, the surgeon was so shocked that Kallio’s body didn’t match his gender identification — not knowing whether to address him as “he” or “she” — that he couldn’t bring himself to tell his patient the grim biopsy results. [...]

Kallio, who is now 56 and lives in New York City, learned “accidentally” that he had breast cancer when the lab technician called to ask how he was doing with his diagnosis. “Which diagnosis?” Kallio asked, horrified.

And it happened a second time, when the medical oncologist was “hostile” and refused to advise him on treatments.

Later, Kallio said the doctor apologized: “I don’t think it interfered with the quality of your care.” In fact, it did. Having to find new doctors delayed the start of chemotherapy beyond the so-called “therapeutic window” for his particularly aggressive form of breast cancer.

Kallio told ABC News that the hostility he experienced from his doctors made it increasingly difficult for him to communicate with them about important information regarding his cancer prognosis, speculating that the doctors may have felt a “moral objection” to his gender identity. He was forced to look for new doctors who he hoped would better treat trans patients, but it has been a long process that has slowed down his treatment.

Fortunately, now that the health care reform law includes a Patient’s Bill of Rights explicitly preventing doctors from denying care based on a patient’s transgender medical history, Kallio’s experience should be a thing of the past. HHS Secretary Kathleen Sebelius has pointed out that “the Affordable Care Act may represent the strongest foundation we have ever created to begin closing LGBT health disparities.”

Kallio is glad to see the reforms put in place by Obamacare, saying that it is “very important” to limit the types of obstacles that he faced in the health care community among transgender people who may not be aware of their rights.

Anti-choice groups are working to block state and national funds to Planned Parenthood’s health clinics across the country, but one organization in New Hampshire has found a slightly different method to prevent the state’s Planned Parenthood clinics from carrying out their work. New Hampshire Right to Life wants to deny Planned Parenthood its pharmaceutical licenses, which would prevent it from filling prescriptions for birth control for women in the state.

Earlier this summer, Republicans attempted to shut down New Hampshire’s Planned Parenthood branches by blocking state funds, citing the familiar far-right argument that Planned Parenthood shouldn’t receive funding for the range of preventative health services they provide for low-income women because abortions make up three percent of their total services. Because the organization was forced to seek direct funding from Washington to keep their health clinics open, the anti-choice group claims that Planned Parenthood is now ineligible to dispense prescription contraceptives:

According to New Hampshire Right to Life, the clinics lost their ability to dispense birth control pills, RU-486, the morning-after pill and related prescriptions in June 2011, when the Executive Council voted to halt state participation in the funding of the clinics. [...]

State law requires a licensed pharmacist to dispense prescriptions, but it contains an exemption for family-planning clinics if they operate under contract with the New Hampshire Department of Health and Human Services.

In April, Right to Life filed a complaint with the Board of Pharmacy claiming that exemption no longer applies.

New Hampshire Planned Parenthood has issued a statement in response to say they are “confident” they are within the bounds of state law and remain eligible for their six pharmaceutical licenses. However, they do have to apply for a renewal of their licenses, and the matter is scheduled for a full Board of Pharmacy hearing next week.