As the White House and Congress grapple with negotiations to prevent yet another showdown over raising the country’s debt limit, hospitals across the nation are worried the so-called “fiscal cliff” will encourage lawmakers to strike a deficit-reduction deal that could cripple safety-net programs and hospitals.

Medicare and Medicaid, two of the budget’s largest entitlement expenditures, are ripe territory for potential cuts in a “grand bargain” on deficit-reduction. But health care advocates like Republican Senate Majority Leader Bill Frist — who is a former physician and an unabashed Obamacare supporter — warn that excessive additional cuts to Medicare- and Medicaid-servicing hospitals could be devastating:

“I don’t think hospitals understand how deep these cuts are going to be in the grand bargain,” Frist said at the World Healthcare Innovation and Technology Congress.

The possibility for more hospital spending cuts on top of those coming under the Patient Protection and Affordable Care Act was not a surprise to some.

“If you just take a look at where the money goes in terms of federal expenditures, healthcare is right there,” said Dr. Robert Laskowski, CEO of Christiana Care Health System, Wilmington, Del. “So the bull’s-eye is an accurate description of the risk.”

In response, his health system is focusing on implementing and expanding quality improvement and cost-savings initiatives. Laskowski said he did not know whether such initiatives by many hospitals would succeed in dissuading deficit negotiators from targeting them.

Safety net hospitals are already worried about the strain they will be under in the states that don’t participate in Obamacare’s Medicaid expansion. The health reform law cut funding to Medicaid disproportionate share hospitals, expecting the expanded Medicaid pool to offset the cost, but those cuts will deeply hurt safety-net hospitals if GOP governors keep refusing to expand their states’ programs.

The potential of looming spending cuts can help encourage doctors and providers to find innovative ways to cut health spending and improve their systems of care. The health law does include some cuts to hospitals’ reimbursements in order to reallocate those funds to reward the hospitals that provide higher quality, less expensive care. But if Congressional leaders shirk difficult budgetary decisions on taxes, defense, and discretionary spending and choose to instead slash funding for safety-net services in a way that spurs contraction instead of innovation, they will be balancing the budget on the backs of America’s sick, poor, elderly, and the hospitals that give them life-saving treatment.

President Obama’s re-election confirms his landmark health care reform isn’t going anywhere, but Republican lawmakers will likely continue their attempts to undermine Obamacare even if they no longer push for an full repeal of the law. In fact, uncompromising Republican governors will likely keep preventing Obamacare from taking effect in their states by standing firm in their resistance to setting up health exchanges and expanding Medicaid.

As Politico points out, whether or not the health reform law is able to operate as it was intended — and expand coverage to about 30 million previously uninsured Americans — largely depends on the extent that governors agree to cooperate in their states. But some Republican governors have already made it clear that they don’t plan on playing nice during Obama’s second term:

Bob McDonnell (R-VA)

McDonnell acknowledged that federal health reform is inevitable now that Obama has been re-elected — but that doesn’t mean he’s ready to cooperate. McDonnell confirmed that Virginia will not be setting up its own health exchange and will continue to refuse to participate in the expansion of the Medicaid program. “I don’t want to buy a pig in a poke for the taxpayers of Virginia,” he said on Wednesday.

Nathan Deal (R-GA)

On Thursday, Deal said his state still doesn’t want any part of Obamacare during the president’s second term and likely won’t work toward setting up its own health exchange. “We’ve pretty well indicated that we don’t like the way that the program has evolved,” he said. Unfortunately for his state’s low-income residents, Deal doesn’t plan to expand the Medicaid program in Georgia either.

Sam Brownback (R-KS)

Brownback chose to put off the decision about setting up a health exchange until after the election, in hopes that a Romney win would eliminate the need to implement Obamacare in his state. But now that the future of the health reform law is secure, Brownback noted on Thursday that he still won’t cooperate with the federal government. “My administration will not partner with the federal government to create a state-federal partnership insurance exchange because we will not benefit from it and implementing it could costs Kansas taxpayers millions of dollars,” Brownback said in a statement.

Rick Scott (R-FL)

Even before the election, Scott made it clear that he wouldn’t set up a health exchange or expand Medicaid in his state. And now that Obama has won a second term, he is holding firm in his opposition to heath care reform, even though Florida has some of the highest rates of uninsurance in the nation. On Wednesday, Scott confirmed that Obama’s re-election doesn’t change anything for him.

Nikki Haley (R-SC)

Like Scott, Haley announced her intention to opt out of both a state-run health exchange and the expansion of the Medicaid program during Obama’s first term. And her administration is showing no signs of changing course now that the election is over. On Thursday, South Carolina’s Department of Health and Human Services director Tony Keck reiterated that the state will not be pursuing its own exchange. “We’ve let them know we’re not going to set up a state-based exchange. It’s a federal program and it’s their responsibility to make it work,” Keck said.

Zane Tankel, the CEO of Applebee’s New York Franchise, Apple-Metro, is so dedicated to not spending money on his employees that he’s refusing to hire anyone new. Why? Because he might have to provide them health care.

Under the Affordable Care Act, a business of 50 people or more must provide a health care option for its employees by 2014. The 40 Applebee’s restaurants in New York employ hundreds of people, and Tankel believes providing them with health insurance plans will be too costly. In an appearance on Fox Business News, the CEO said he won’t be able to hire new people because of the law, and even floated the idea of layoffs:

TANKEL: We’ve calculated it will be some millions of dollars across our system. So what does that say — that says we won’t build more restaurants. We won’t hire more people — exactly the opposite of what the President says.

HOST: Do you feel under pressure to move to a more part-time workforce, as other restaurants are doing because of Obamacare?

TANKEL: The model’s been set. I’m sure all our people are watching this right now, so I don’t want to make any commitments one way or another. I just want to say we’re looking at it, we’re evaluating it, if it’s possible to do without cutting people back, I’m delighted to do it. But that also rolls back expansion, it rolls back hiring more people, and in a best-case scenario we only shrink the labor force minimally.

Watch it:

It is virtually impossible that a company the size of Applebee’s will be able to avoid providing health care in the long-term — and it’s not really in their interest, either. Studies have shown that a company that provides health care has a higher retention rate for its employees, reports more employee satisfaction, and draws the best employees to the job.

And although providing his employees with affordable health insurance doesn’t seem to be a priority for Tankel, they likely have no other options when it comes to accessing health care. Many low-wage workers in the restaurant industry often don’t qualify for Medicaid because they earn salaries that are just barely over the threshold, but they also don’t make enough to be able to afford insurance on the private market.

After surviving a year-long battle in Congress, a Supreme Court challenge, and the presidential election, Obamacare is here to stay. Just yesterday, GOP House Speaker John Boehner admitted yesterday that Obamacare is, in fact, “the law of the land.”

But Boehner was quick to walk back his comments via Twitter, reasserting that the GOP’s wish is still to fully repeal or severely dismantle the law. Since the Senate and the presidency remains solidly in Democratic hands, the GOP has their work cut out for them. But that doesn’t mean they won’t try their best to beat back, sue, and defund Obamacare provisions in an effort to neuter the law at the cost of Americans’ health and financial security. Here are three ways that the GOP will likely attempt to attack and undermine Obamacare provisions:

1) Denying federal insurance subsidies to Americans under health exchanges. If states can’t make a decision by November 16th about whether to set up health insurance exchanges, the federal government will set up one for them. But House Republicans may try to throw a wrench into those plans. Republicans are claiming that a minor technicality in the health reform legislation restricts its health insurance subsidies to Americans living in states that set up their own exchanges, and doesn’t extend to the Americans in states where the federal government sets up an exchange. This is obviously not what the health reform law intends, and IRS Commissioner Doug Shumlin has already issued an IRS-rule setting aside subsidies for Americans in all states. But Republican leaders may pursue this line of obstruction for insurance subsidies, essentially leaving sick and needy Americans to fend for themselves by denying them the subsidies that would make it possible for them to afford health coverage.

2) Resisting the Medicaid expansion. ThinkProgress has consistently reported on how Obamacare’s Medicaid expansion will significantly lower state health care costs while extending insurance to as many as 30 million low-income Americans — but only if the states agree to take part in the expansion, which the Supreme Court ruled optional. Even after President Obama’s re-election, GOP governors in states such as Florida are digging in their heels against reform. Sadly, many of the expansion’s GOP detractors lead states with extremely large uninsured populations, and their refusals to implement Medicaid reform might leave millions of low-wage workers without the health coverage they depend on.

3) Undermining the medical device tax and Independent Payment Advisory Board (IPAB). The device tax and IPAB are ways that Obamacare raises revenue for its vast coverage expansion and controls the rate of Medicare spending. Republicans are already eyeing the 2.3 percent medical device tax, calling it a burden on American businesses. But repealing the device tax risks grossly under-funding Obamacare’s insurance subsidies to Americans, meaning that Republicans are seeking to lower big manufacturers’ costs by shifting the burden onto Americans’ subsidized insurance premiums in 2014. Similarly, the independent, 15-member IPAB looks to keep American health spending at sustainable levels by finding ways to control Medicare spending growth without compromising on quality or benefits. While some of these cuts may be painful at first for hospitals and some physicians, the savings accrued will act as a firewall against seniors’ rising premiums and assure that providers, rather than everyday Americans, are bearing the burden of lowering medical spending.

Americans can expect continued battles over the proper funding and implementation of Obamacare in the coming months — for example, employer groups are almost certain to challenge the law’s provisions requiring that all large employers offer their workers health benefits. But now that the uncertainty over Obamacare’s future no longer exists, it isn’t too difficult to see what attempts to weaken the law really are: giveaways to large corporations, providers, and partisan politicking at the expense of real Americans’ health care and financial security.

Last year, anti-choice advocates in Ohio pushed extreme legislation to ban abortions after a fetal heartbeat is detected — which often occurs as early as six weeks, before many women may even know they’re pregnant. So-called “heartbeat” bills like HB 125 are so radical that they often divide the anti-abortion community, and this particular legislation has been stalled in the Ohio Senate since June 2011.

But now, thanks to significant pressure from the anti-choice groups who were the biggest proponents of the heartbeat bill last year, HB 125 may be up again for consideration in Ohio’s Senate as early as next week:

Mired in the Ohio Senate since June 2011, HB 125 is getting another look, Senate President Tom Niehaus, R-New Richmond, told The Enquirer Thursday. He said a substitute bill is being prepared. [...]

[Anti-abortion group Faith2Action] took aim at Niehaus and other legislators, including Sen. Shannon Jones, R-Springboro, trying to pressure them into moving the bill. They and other legislators were inundated with telephone calls, emails and post cards from supporters of the bill. TV ads, billboards and even an airplane circling the statehouse dragging a sign targeted legislators. [...]

Niehaus said he set conditions for reconsidering the bill. He would not say what those conditions are or whether the bill’s proponents had met them. That’s what he’s going to consider next week, he said.

If passed, Ohio’s bill would be the most restrictive abortion ban in the nation — far surpassing a bill in Arizona that currently earns that unfortunate distinction by banning abortions after 20 weeks. HB 125 would criminalize all abortions after the fetal heartbeat is detected without even the narrowest exceptions in cases of rape, incest, or the mental health of the woman.

Kellie Copeland, the executive director of Naral Pro-Choice Ohio, told the Cincinnati Enquirer that her organization was anticipating the Senate would take up HB 125 during this fall’s lame duck session. But she noted that this week’s election results are a clear indicator that voters reject radical anti-abortion legislation.

“Voters in Ohio and across the country clearly rejected this anti-choice agenda, the ability of women to make their own private medical decisions,” Copeland said. “That they would attempt these kind of major attacks less than a week after the election just shows that they don’t care what voters have to say. It’s their extremist agenda and voter sentiments be damned.”

Exit polls report that a narrow majority of voters who self-identified as Catholic chose to cast their ballot for the president. Fifty percent of the sampled Catholic voters went to Barack Obama, compared to 48 percent for Mitt Romney. While the numbers aren’t overwhelming, they do reveal that efforts to turn broad swaths of Catholics away from Obama by framing his health care reform law as an affront to religious liberty fell somewhat flat.

Throughout the campaign, Obamacare opponents claimed that the law’s provision requiring employer-based insurance plans to cover contraceptive services without a co-pay compromised the religious freedom of the Catholics who opposed those services — even though the birth control regulation already includes an exemption for places of worship, as well as a widely-supported workaround allowing Catholic-affiliated institutions to shift the cost of contraception coverage onto outside insurers. Just the week before the election, a robocall financed by the Romney campaign told voters that President Obama is a “threat to our religious freedom” because he “forced Christian organizations” to provide birth control coverage that goes against their beliefs.

But despite the misleading political campaigns against Obamacare — and even though Catholic leaders often misused their positions of power to advocate against Obama — Catholic voters haven’t been persuaded. In fact, several polls have shown that the majority of Catholics agree with the contraception mandate and believe that religiously-affiliated institutions should be required to cover birth control to their employees at no extra cost. And 82 percent of Catholics don’t actually think that birth control represents a threat to their beliefs, even though the Church hierarchy continues to frame the issue in this way.

Even though Obama’s re-election means that the health care reform law is here to stay, opponents of the birth control mandate are continuing to fight it. So far, more than 110 plaintiffs have filed over 40 lawsuits against the Affordable Care Act’s contraception provision. Several of those lawsuits have already been struck down — and so far, they aren’t winning over voters, either.