Health and Human Services (HHS) Secretary Kathleen Sebelius announced on Monday that, for now, states will not be able to receive full federal funding if they choose to implement partial Medicaid expansions. States will need to fully expand the program to be eligible for the matching funds under Obamacare that will offset the cost of the program.

Although the Supreme Court upheld the bulk of the landmark health reform law last summer, Obamacare’s proposed Medicaid expansion was scaled back when the court ruled that states should be able to decide whether or not to expand their programs. Since then, GOP governors have been digging in their heels against reform, refusing to expand their states’ Medicaid pools to extend affordable insurance to millions of low-income Americans. That’s led lawmakers in several GOP-run states, such as Texas and Louisiana, to toy with the idea of partially expanding Medicaid in individual counties as a way of overcoming their governors’ continued obstruction.

But Sebelius has confirmed that pursuing that option will make states ineligible for the matching funds that the federal government will offer to the states that choose to fully expand Medicaid:

[W]e explain how Exchanges and Medicaid administrative costs will be funded and how we will continue exploring opportunities to provide States additional support for the administrative costs of eligibility changes. We clarify in our new guidance that states have the flexibility in Medicaid and the Children’s Health Insurance Program to provide premium assistance for Exchange plans as well as to adopt “bridge plans” that offer coverage through both Medicaid and Exchanges – keeping individuals and families together when they cross the line between Exchanges and Medicaid. And, while the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty, we will consider waivers at the regular matching rate now and, in 2017 when the 100 percent federal funding for the expansion group is slightly reduced, broad-based State Innovation Waivers.

We hope states will take advantage of the substantial resources available to help them insure more of their residents. As an independent report highlighted, “Accounting for factors that reduce costs, states as a whole are likely to see net savings from the Medicaid expansion.”

In fact, several independent reports have highlighted the cost-cutting potential of Obamacare’s Medicaid expansion.

Without full federal matching funds for partial expansions, the stakes have been raised for recalcitrant GOP governors and legislatures, who control the state governments of seven out of the ten least-insured cities in America.

Frank J. Morrocco was released from federal prison last December, after serving 20 years behind bars for a drug conspiracy conviction. But last month, Morrocco wanted to go back. He shoplifted from a local grocery store with the intention of getting arrested and getting sent to jail for a second time.

Why was Morrocco so eager to be put back behind bars? He suffers from a rare form of leukemia and lacks health insurance — he doesn’t have an employer-based plan because he is self-employed as a car buyer, and he falls into the gap between earning too much to qualify for Medicaid coverage and too little to be able to afford insurance on the private market — so he’s unable to access the treatment he needs. As the Buffalo News reports, Morrocco felt like prison was his only viable option under the circumstances:

That way, Morrocco said, he would be able to get “prison health care that is very good” — health care that he says he cannot afford as a free man.

“It was an act of desperation. I went into that store and took things I didn’t need, and I made sure a lot of people saw me,” the 56-year-old Morrocco told The Buffalo News. “At the time I did it, I felt that I didn’t have any other way to get the care that I need for my leukemia.” [...]

Attorney Joel Daniels is now representing Morrocco. On Saturday, Daniels referred to the situation as “a very sad case, very unfortunate.”

“Hopefully, down the road, when Obamacare kicks in, you’ll no longer have situations like this,” Daniels said. “You’ll no longer have cases where a man is trying to get into prison to get better health care.”

After Morrocco was diagnosed with leukemia in prison in 2008, he was sent to a medical prison facility in North Carolina to receive regular check-ups, chemotherapy, and blood work. Since being released from prison, he’s only occasionally visited the doctor because he can’t afford it. After he got too weak without regular chemotherapy treatments over the summer, he did end up in the hospital twice — but now that he’s racked up over $5,000 in medical bills, he says he doesn’t have the money to go back.

Obamacare’s Medicaid expansion is crucial to funding health care for ex-convicts like Morrocco, since it will help extend coverage to the underemployed or unemployed Americans who cannot currently afford to purchase insurance on the private market. But until the health reform law is fully implemented in 2014 — or if stubborn Republican governors continue to resist expanding Medicaid in their states — the soaring cost of health care is still forcing some uninsured Americans to go to desperate lengths to attempt to fund their medical costs. Those without adequate coverage are increasingly turning to the Internet to attempt to crowd source the funds they need to pay off their rising medical debt.

Since being arrested for shoplifting about $23 dollars’ worth of items, Morrocco has had second thoughts about his plan to return to jail. But he still feels like he doesn’t have many choices available to him. “Do I want to go back to prison? No,” Morrocco told the Buffalo News. “But do I want to die on the outside because I can’t afford health care? No, I don’t want to do that, either.”

The Supreme Court is already preparing to take up several game-changing cases next year on issues ranging from human gene patenting to promoting the off-label use of drugs. And now the nation’s highest court is slated to hear another landmark case within the pharmaceutical industry that could have enormous ramifications for Americans’ prescription drug costs.

Federal Trade Commission v. Watson Pharmaceuticals addresses the widespread practice of “pay for delay,” a scheme in which brand name drug manufacturers — whose products are considerably more expensive than their generic counterparts — pay off generic drug manufacturers in exchange for their consent to delay the release of a drug’s generic version into the market. While the drug industry claims the controversial practice is more efficient than potential costly patenting lawsuits over similar drugs, federal trade regulators argue that it actually serves to line industry pockets at the expense of American consumers:

“This is the health care reform case of 2013,” said David Balto, a former FTC policy director who helped file the first lawsuit against pay-for-delay deals back in the 1990s. “There’s no other case that can have as much impact on reducing health care costs.”

The FTC has estimated the deals cost consumers $3.5 billion annually by delaying access to cheaper generics, an estimate disputed by pharmaceutical companies. The Congressional Budget Office estimated that legislation introduced to restrict the deals would save the government more than $2.5 billion over 10 years in federal health care spending. [...]

FTC Chairman Jon Leibowitz has made the delay-deals a signature issue, arguing that they illegally prop up profits for drug companies at the expense of consumers. And in July, the U.S. Court of Appeals for the 3rd Circuit sided with the FTC, upsetting more than 10 years of precedent upholding the arrangements.

The case is particularly relevant in an era of skyrocketing brand name drug prices. Proposals to lower Medicare spending without harming benefits also often involve negotiating Medicaid drug rebate rates for Medicare beneficiaries — a tactic that would benefit even further from the earlier release of generic drugs.

A new study in the Pediatrics journal finds that an estimated 30 percent of U.S. adolescents are the victims of an “aggressive heterosexual dating relationship,” a particularly troubling statistic given the significant public health risks that can result from intimate partner violence in teenage relationships. The authors of the study note that their work represents one more addition to a growing body of research that suggests teen dating violence “is a substantial public health problem” in the United States.

Researchers analyzed a nationally representative sample of more than 5,000 U.S. adolescents between the ages of 12 and 18 to determine whether or not they were engaging in healthy romantic relationships. About 20 percent of respondents of both genders said they had experienced some type of psychological violence within a dating relationship, and ten percent of girls and eight percent of boys cited both psychological and physical violence. And when researchers followed up with the same participants five years later, they found that those who had experienced dating violence as teens were two to three times more likely to be in violent relationships later in their lives.

And the consequences of teen dating violence appeared to impact young women and men slightly differently. The teen girls who were victimized by a boyfriend were more likely to engage in risky behaviors like smoking and heavy drinking five years down the line, and they also had an increased chance of experiencing symptoms of depression and thoughts of suicide. The teen boys who were victimized by a girlfriend were likely to exhibit increased anti-social and delinquent behaviors and have suicidal thoughts. The lead author of the study, Deinera Exner-Cortens, told USA Today that more research is necessary to determine how aggression functions in teen relationships and why intimate partner violence impacts teen girls and boys differently.

Exner-Cortens did suggest that the power imbalance in abusive heterosexual relationships often tips toward men. “We know that girls are more likely to experience more severe physical violence, sexual violence and injury, and they report more fear around their aggressive dating experiences,” she explained.

Since researchers found such a high risk for re-victimization among young adults who had experienced dating violence earlier in their lives, the study’s authors recommend investing in screening and prevention programs to adequately address issues of intimate partner violence in our society. But the issue doesn’t seem to be a current priority for legislators in Washington. The Violence Against Women Act — which has helped protect countless survivors of domestic assault since its introduction in 1994 — is currently languishing in Congress because Republican leaders aren’t convinced it should ensure protections for Native American women.

Obamacare extends health insurance to tens of millions of Americans, assists the nation’s most vulnerable by outlawing the worst excesses of the private insurance industry, and keeps Medicare solvent for American seniors. And the Wall Street Journal observes that the landmark health law will prove a crucial asset to yet another segment of the American population: those who are are trapped in their current jobs out of fear for losing access to health insurance.

This phenomenon — known in the industry as “job lock” — is an unintended consequence of America’s primarily employer-sponsored health insurance system. Studies have shown that workers who don’t receive insurance through their employers are one and half times more likely to switch jobs than the workers who have employer-sponsored plans. Since insurance coverage can’t be shifted between jobs, some Americans remain in their current positions longer than they would have otherwise because of their fear of losing health coverage, since private insurance might prove unaffordable for them.

This problem is particularly prevalent among older employees in their 50s and 60s, some of whom remain in their jobs simply because they are waiting to qualify for Medicare coverage. Even aside from the fact that this dynamic forces some people to work longer than they might want to, it also creates an inefficient labor market, since workers might not switch over to higher-utility job in order to maintain continuous benefits.

Luckily, Obamacare’s insurance exchanges will allow individuals to purchase coverage on a statewide market, and the law gives consumers tax subsidies with which they can purchase care. Furthermore, small employers might be less likely to forgo hiring due to coverage costs, since Obamacare actually reduces smaller firms’ health care spending.

But proposals to raise the Medicare eligibility age from 65 to 67 would undo some of the progress made by Obamacare in this regard, forcing elderly Americans to work for even longer and exacerbating the “job lock” phenomenon — all while reducing health care spending marginally and shifting costs onto states, employers, and Americans’ health insurance premiums.

As recalcitrant Republican governors still refuse to consider expanding their state’s Medicaid programs under Obamacare — despite several studies confirming that the optional Medicaid expansion will save states money and strengthen the hospital safety net system — state lawmakers have begun to pursue creative solutions to extend Medicaid coverage to their low-income constituents.

After Gov. Rick Perry (R-TX) rejected a state-wide Medicaid expansion in Texas, several counties investigated the possibility of moving forward on their own, potentially raising the eligibility threshold for their local Medicaid rolls even if the program wasn’t able to be expanded throughout the entire state. And in Nebraska, State Sen Jeremy Nordquist (D) has taken the lead on crafting a bill to expand Nebraska’s Medicaid eligibility levels that he plans to introduce when the state legislature reconvenes in January. Even though Gov. Dave Heineman (R) remains staunchly opposed to the health care reform law and would likely veto a bill to participate in Obamacare’s Medicaid expansion, Governing reports that Nordquist wants to find a way to override his veto:

Nordquist says he believes the legislature could muster up enough votes to override Heineman’s veto. It takes 30 votes from the 49 lawmakers in the state’s unicameral legislature to overturn a governor’s veto. There will be 17 Democrats and two independents who will likely caucus with them in 2013, which means at least 11 Republicans would have to buck their national party line and support a key provision of the ACA. [...]

How will Nordquist bring them around? It’s a fiscal argument, he says. The state legislative fiscal office estimated that Nebraska will spend $123 million by 2020 on the expansion. But there will also likely be savings and new revenue. The fiscal office projected the state would save $100 million by 2020 because of the ACA provision that guarantees coverage regardless of preexisting conditions, which will eliminate the need for a state program that provides subsidies for high-risk insurance buyers. That money alone almost offsets the cost of the expansion, Nordquist notes.

And Nordquist is confident in his ability to override his governor because he’s done it before. In 2010, after Heineman vetoed a bill that would have extended prenatal care to undocumented immigrants through the state’s Children’s Health Insurance Program — claiming that Nebraska shouldn’t have to fund health care for immigrants who didn’t enter the country legally — Nordquist successfully built a coalition of 15 Democrats and 15 Republicans who voted to override Heineman’s veto. This year, Nordquist already has support from Nebraska’s Republican health committee chair, who has confirmed she will propose the bill because she supports Medicaid expansion.

Nordquist was able to wrangle bipartisan support in 2010 partly by “appealing to the pro-life beliefs of the Republicans” when making his case for extending health coverage to the Nebraska residents who need it most. That could prove be a good strategy for this legislative fight, too. National faith leaders have already urged Republican governors to expand the “pro-life” Medicaid program because “depriving struggling families of healthcare is wholly incompatible with the teachings of our faiths and the ideals of our nation.”

More than 21 million low-income Americans stand to gain health coverage under Medicaid if governors like Heineman choose to participate in Obamacare’s expansion of the program.