Former convicts who have left the prison population face particularly daunting challenges in America, including struggling to gain access to health care coverage. Due to the fact that ex-prisoners have a significantly higher unemployment rate than the average population, almost all male ex-prisoners struggle to obtain insurance through an employer. Obamacare can help change the high uninsurance rates among America’s former inmates — but only if states agree to participate in its Medicaid expansion.

Despite the fact that the health care reform law’s proposed expansion of the Medicaid program could help provide millions of low-income Americans with coverage they currently can’t afford, as many as half a dozen Republican governors are refusing to expand their Medicaid pools. Ex-prisoners living in such states will almost certainly be forced to pay for medical care out-of-pocket. On the other hand, stories out of the states that have begun to expand access to their Medicaid programs highlight the profound cost- and life-saving potential this Obamacare provision promises for ex-prisoners in particular.

California, which has the country’s second-largest inmate population behind Texas, initiated its Medicaid expansion late last year. According to an NPR report, the resulting decrease in poor adults’ uninsurance rates has been a boon to ex-cons who often move in and out of the prison system, providing them access to wellness initiatives, chronic illness treatments,  and care for everday medical problems that often go untreated:

[Dr. George Pearson] says a 45-year-old ex-convict will often have the ailments of someone 10 years older. Ex-convicts have higher rates of almost all chronic conditions, like high blood pressure, diabetes and asthma. It’s from living a hard life, to be sure, he says, but it’s also because they have common medical problems that go untreated.

“So the hypertension becomes heart failure, the diabetes becomes diabetic neuropathy, amputation, blindness,” Pearson says.

Now, many of those getting out of prison and other poor adults in California are being enrolled in a Medicaid-like program where they will be covered for preventive care, prescription drugs, specialty visits, mental health and substance abuse — pervasive problems that when left untreated, researchers say, can lead offenders right back to prison or jail.

Washington, D.C. has seen similarly positive results with former prisoners since opening up its Medicaid program. As Dr. Ilse Levin of southeast D.C. explains, “Now, everyone gets Medicaid. And suddenly I can get them their medications, I can get them to see a specialist, I can get the studies done. And it is amazing. It’s completely changed my practice.”

State experiences such as these underscore the significant difference that Obamacare’s Medicaid expansion makes in the lives of America’s most vulnerable populations. If Republican governors and state legislatures continue their political crusade against the expansion, it will be at the cost of helping those who need it most.

Following the Supreme Court’s ruling to uphold the health care reform law under Congress’ taxing power, Republicans misconstrued its individual mandate as a “massive tax hike” on the middle class. This week, after the Congressional Budget Office upped its estimate on the number of Americans who are expected to face a penalty in 2016 for failing to purchase health insurance — increasing their original 4 million figure to 6 million — conservative outlets once again lamented the middle class families who will be “hit with a tax hike.”

But the revised 6 million figure does not mean the health care law puts a strain on the middle class. In fact, Obamacare will provide millions of families with large tax credits to help make health care more affordable for them, and the penalty will only be leveled against those Americans who choose not to purchase insurance even though they are able to afford it. The penalty from the individual mandate is projected to affect just 2 percent of the American population. The Center for American Progress shows how Obamacare represents a major tax cut for many families, even with the CBO’s new estimate:

The CBO pointed out that some of the increase in their revised figure reflects Republican governors’ opposition to expanding the Medicaid program in their states to provide more of their low-income residents with health coverage.

After Rep. Todd Akin (R-MO) asserted his belief that “legitimate rape” doesn’t often lead to pregnancy, Republican lawmakers were quick to attempt to configure his radical stance on women’s health as an outlier in their party. However, increasing numbers of GOP politicians’ language about the nature of sexual assault actually echoes Akin’s — including New Mexico Gov. Susana Martinez (R), whose state’s policies use language that effectively narrows the definition of rape.

Not only did Martinez refer to “forcible rape” in an announcement instating April as New Mexico’s Sexual Assault Awareness Month — as if some kinds of sexual assault need to be qualified as more or less “legitimate” than others — but, as RH Reality Check reports, the term also appears in the state’s proposed changes to its official applications for childcare assistance. If the proposed changes take effect, women in New Mexico will be required to prove that their sexual assault qualified as “forcible rape” if they are seeking childcare assistance for a child that resulted from rape:

If adopted, this policy will have numerous implications. It establishes in state law a narrow definition of rape that can and will be applied in other areas of law and policy. It puts a heavy burden on women who have been raped and are now struggling economically to support a child or children to prove the manner in which they were raped and to meet a test set up by the state to exclude many women in need of childcare assistance who would otherwise qualify.

It would force women who have left violent domestic partnerships, who were date-raped, who were impregnated as a result of incest, or through other “non-forcible” but nonetheless equally violent and denigrating means of sexual violation to first re-engage with their abusers to seek child support, putting control of their lives back into the hands of someone by whom they were violated in the most profound sense of the term.

Martinez’s problematic move to narrow the definition of sexual assault is not unique to her state. Last year, vice presidential candidate Paul Ryan partnered with Akin to co-sponsor a bill that introduced the concept of “forcible rape” in one of its earlier drafts. The “forcible rape” language was eventually removed from that bill after widespread public outcry, but that hasn’t stopped the concept from permeating the Republican Party.

Women’s health advocates in New Mexico are fighting back against the proposed changes to the childcare assistance applications. Strong Families, a coalition that works to advance the rights of women and immigrants, released a statement expressing their disappointment in Martinez’s “attempt to qualify differing levels of rape,” calling the move “especially egregious” in light of the fact that Martinez was a prominent speaker at last month’s Republican National Convention. A hearing on the issue is scheduled for October 1st.

Update

RH Reality Check has received confirmation from New Mexico’s Children, Youth, and Families Department that Martinez has requested the removal of the “forcible rape” language from the state’s childcare assistance applications. A statement from department explained, “The Governor feels the language is redundant and unnecessary, and she does not support its usage.”