One aspect of the Affordable Care Act still in contention is the law’s expansion of Medicaid — the health care program for the disabled, seniors, and low-income Americans that’s jointly funded by the federal government and the states. The Supreme Court’s ruling on health care reform back in June determined that states could chose to opt out of the expansion without losing the federal Medicaid dollars they already recieve. Several governors — all of them Republicans — have already taken the opportunity to declare their state will not participate in the program’s expansion.

These refusals are often justified on budgetary grounds: Medicaid’s burden “increasingly shifts to Florida taxpayers in future years” and was “growing three and a half times as fast as Florida’s general revenue” as Governor Rick Scott put it. Georgia Governor Nathan Deal said of the expansion, “I think that is something our state cannot afford.” And Rick Perry, the ever blunt governor of Texas, declared, “I will not be party to… bankrupting my state.”

Ironically, however, a recent analysis by the Center on Budget and Policy Priorities determined that the budget Paul Ryan engineered in the House — which was passed by the governors’ own party, and endorsed by Rick Perry and the other leaders of the Republican Governors Association — would cost states’ budgets well over ten times as much as the ACA’s Medicaid expansion.

The CBPP determined that between now and 2022 the Medicaid expansion would cost states $73 billion. Over that same time period, the House GOP budget would cut $810 billion from the federal government’s contribution to Medicaid, on top of its repeal of the ACA’s Medicaid expansion. The budget would also cut another $281 billion from federal support for schools and other state and local services. A grand total of $1.091 trillion in losses to state budgets.

In fairness to the governors, the Urban Institute ran the numbers and found that the cost of expanding Medicaid would not fall evenly on the states. (It should be noted their estimates only run through 2019.) And the majority of the states either refusing, or leaning towards refusing the expansion, have populations with unusually high portions of people that are currently uninsured but would be eligible to join Medicaid.

But even under the Urban Institute’s worst-case predictions, several of the refusing or leaning-towards-refusal states still see net savings from the new federal dollars that come with the expansion. And for those that still see net costs, such as Texas and Florida, the highest predicted budgetary hit was in the vicinity $2.5 billion. Almost certainly, that comes no where close to matching the damage that would be done if the House GOP’s budget became law.

Meanwhile, the number of uninsured Americans fell by 1.3 million in 2011 — the first time it’s gone down in four years. In no small part, the decrease was due to a boost in Medicaid and CHIP funding included in the 2009 stimulus. If all the states carry through with the far greater boost the ACA’s expansion would bring to Medicaid, as many as 17 million currently uninsured Americans could finally gain coverage.

A recent investigation by the Justice Department’s Civil Rights Division found that the administration of Florida Gov. Rick Scott (R) has been holding hundreds of disabled children in nursing homes for long stretches of time. Scott’s administration, however, is denying the charge.

Investigators sent a letter to Florida Attorney General Pam Bondi last Thursday concluding the state is violating the Americans with Disabilities Act after visiting 200 children in six nursing homes. The 22-page letter detailed how sick and disabled children are forced into geriatric nursing homes, often isolated from their families and other children for years at a time:

Hundreds of children are currently segregated in nursing facilities throughout Florida. They are growing up apart from their families in hospital-like settings, among elderly nursing facility residents and other individuals with disabilities. They live segregated lives — having few opportunities to interact with children and young adults without disabilities or to experience many of the social, educational and recreational activities that are critical to child development.

According to the DOJ, the average stay is three years, and as many as 50 kids were held for over five years. The letter also noted how unnecessary this traumatic practice is: “With adequate services and supports, these children could live at home with their families or in other more integrated community settings.” As an example, the investigation highlighted the mother of a 5-year-old child rendered quadriplegic by a car accident, who cannot bring her child home from a state facility because the waiting list for community and home-based services is 5-10 years.

Unfortunately, Governor Scott has rejected millions of federal dollars specifically for children’s health care. As Adam Serwer at Mother Jones points out, this money would have helped finance home and community services that would allow disabled children to stay home with their parents.

Elizabeth Dudek, secretary of Florida’s Agency for Health Care Administration, said the DOJ’s findings were full of “unfounded allegations” and has dispatched staffers to talk to these families. The DOJ will likely move forward with a lawsuit now that the AHCA has denied the charges. The state is also facing a class-action lawsuit filed on behalf of 300 institutionalized children.

Yesterday afternoon, the Republican-controlled Missouri legislature overrode Gov. Jay Nixon’s (D-MO) veto of a bill that would allow employers to deny coverage for contraceptive services that violate their religious beliefs, ensuring that the legislation will immediately go into effect. Women’s health advocates are already pushing back on what they describe as an affront on the reproductive freedom of the state’s female residents.

Planned Parenthood’s national office, as well as the organization’s local affiliate, released statements condemning Missouri legislators for “treating women as second class citizens,” pointing out that the measure prevents women from being in control of their own preventative health care:

“Today, the Missouri legislature callously ignored the 700,000 Missouri women that use some form of birth control, and — by allowing SB749, the Birth Control Refusal bill to become law — put employers and insurers in charge of their birth control decision-making,” Planned Parenthood says in a press release.

“The Missouri legislature, beholden to lobbyists that see an abortion in every birth control pill, has done a huge disservice to all Missouri women,” says Peter Brownlie, President and CEO of Planned Parenthood of Kansas and Mid-Missouri. “Birth control is not just basic, preventive health care for women, it is a pocketbook issue. Without this new birth control coverage benefit, many women will now have to continue paying $15 to $50 a month on top of their premium. When you live paycheck to paycheck, that’s a lot of money!”

And a Kansas City labor union filed suit against the law today, hoping to block it from going into effect in Missouri on the grounds that state law cannot trump the federal health care reform law, which includes a provision requiring employer-based insurance plans to cover contraceptive services free of charge. The union’s lawyer explained that ensuring access to affordable birth control is a labor issue:

“We are coming fast out of the gate on this to show that labor is going to put its foot down on attempts to divide workers and deny workers their right to heath care,” said Edward Keenan, a labor lawyer with Keenan Law Firm in Kansas City who is representing the union in the lawsuit. [...]

“We consider this move to be just another right wing assault on workers — limiting our members’ options and choices,” Keenan said.

Missouri’s birth control measure — which passed the legislature in May and was vetoed by Nixon in June — is modeled on a federal law proposed by one of its senators, Roy Blunt (R-MO), that failed in the Senate. The Obamacare provision that this type of legislation intends to circumvent went into effect on August 1.

The Obamacare provision that requires employer-based insurance plans to offer contraceptive coverage without a co-payment went into effect on August 1, but conservative Catholic institutions are still hoping to defeat it in court. Catholic challengers against the health care reform law claim it violates their religious liberty, despite the fact that the contraception mandate already includes an exemption for religious institutions that shifts the cost of birth control to insurance companies so the religious institutions will not have to directly pay for services that they morally oppose.

In Tennessee, the Diocese of Nashville and seven other local Catholic institutions are adding their own legal challenge to the increasing pile of Catholic lawsuits against the health reform law. However, in addition to not being satisfied with the Obamacare mandate’s existing religious exemption that several federal judges have agreed offers sufficient protection for religious liberty, the Tennessee institutions seem to be misinformed about the true costs of women’s preventative care. The language of the lawsuit suggests that birth control is already “freely available” for women in the United States, so there is no reason they need it to be covered in their insurance plans:

In their suit, the organizations say it’s not about whether people have a right to abortion-inducing drugs, sterilization, and contraception.

“Those services are and will continue to be freely available in the United States, and nothing prevents the Government itself from making them more widely available,” the suit says.

“But the right to such services does not authorize the Government to force the Plaintiffs to violate their own consciences by making them provide, pay for, and/or facilitate those services to others, contrary to their sincerely held religious beliefs.”

In reality, the high cost of contraceptive services — a year’s supply of oral birth control pills, the most common form of contraception, typically costs over $1,200 out of pocket — can be a significant barrier for women. Nearly one in three women report they have stopped using their preferred contraceptive method, or used it less consistently and effectively, because they could not afford it. And health costs already disproportionately fall on women rather than men. Women of reproductive age currently spend about 68 percent more than men do on out-of-pocket health care costs, partly because of high contraception costs.

The lawsuit suggests that the government should take steps to make birth control more widely available to women if it is something the administration supports. The birth control provision of the health care reform law is a step to do just that. The administration is attempting to ensure affordable preventative care for Americans regardless of gender, and it’s not true that “nothing prevents” it from doing so when these Catholic institutions continue to stand in the way.