California’s state Medicaid program, Medi-Cal, has struggled to remain fully funded as its budget — and particularly the reimbursements that go toward the doctors who accept poorer patients under the program — perennially falls under the knife. And the low-income Americans who need specialist care are particularly susceptible to the shortcomings of the strained social safety net.

The Los Angeles Times reports that poor Americans seeking access to specialist services — such as complex surgeries and neurological treatment — are faced with a dearth of specialists willing to service Medi-Cal, mostly due to its historically low reimbursement rates. And on top of that, the United States continues to face a growing doctor shortage that is leading to long waiting periods for Americans:

By the end of the decade, the nation will be short more than 46,000 surgeons and specialists, a nearly tenfold increase from 2010, according to the Assn. of American Medical Colleges. Healthcare reform is expected to worsen the problem as more patients — many with complex and deferred health needs — become insured and seek specialized treatment.

Many of the newly insured will receive Medi-Cal, the government plan for the needy as administered through the state of California. Clinics already struggle to get private specialists to see Medicaid patients because of the low payments to doctors. Last week, an appellate court decision that authorized the state to move forward with 10% cuts in Medi-Cal reimbursement, which could make finding doctors for those patients even more difficult.

“Specialists are paid so poorly that they don’t want to take Medi-Cal patients,” said Mark Dressner, a Long Beach clinic doctor and president-elect of the California Academy of Family Physicians. “We’re really disappointed and concerned what it’s going to do for patient access.”

This shortage disproportionately affects Americans on Medicaid because the program’s lackluster funding makes it difficult to attract specialists who — after expensive and time-consuming stints in medical school — are willing to take on poor patients for lower reimbursements. Unfortunately, saddled with long waiting periods for specialist treatment, some Americans resort to inefficient and expensive emergency room care, raising health care spending nationally.

Obamacare seeks to quell this problem by vastly expanding funding for states that open up their Medicaid pools to more Americans and providing medical schools incentives for producing more general practitioners and family doctors. But as the LA Times notes, the medical school incentives do not also extend to specialists, and all the extra Medicaid funding in the world will mean little if states do not offer doctors reimbursements high enough to attract their services.

Since the downward trend in Americans becoming doctors has long been in the pipeline, the health reform law is not the root cause of this shortage. But since Obamacare expands the Medicaid program to extend coverage to millions of previously uninsured Americans, it does highlight just how deep the existing shortage is.

In the aftermath of the recent mass shooting at Sandy Hook Elementary School in Newtown, CT, Americans are once again considering the role that mental illness plays in violent crimes, and calling for improved care for the mentally ill to help reduce future gun violence. But although there are serious problems with the way mental illness and psychiatric disorders are treated in this country, future tragedies are unlikely to be avoided if improving mental health care is the only step this country takes to reduce gun violence.

It’s true that Jared Loughner and James Holmes — two men behind recent mass shootings in the United States — had documented histories of mental illness, but that isn’t enough evidence to make the broad conclusion that mentally ill individuals are predisposed to violent behavior or violent crimes. Despite popular perceptions, evidence actually suggests the mentally ill are no more prone to violence than the general population.

Between 92 and 96 percent of mental patients don’t have violent tendencies, and studies show the mentally ill are more likely to be the victims of violent crimes themselves than the criminal perpetrators. In fact, histories of substance abuse and other socio-demographic and economic factors are stronger determinants of violent behavior than psychiatric disorders. The contribution of the mentally ill to overall crime rates is an extremely low 3 to 5 percent, a number much lower than that of substance abuse.

Nevertheless, both the media and entertainment industry often depict the mentally ill as violent criminals. According to Mental Health American, 60 percent of characters in prime time television with mental illness were shown to be involved in crime or violence, and news reports overwhelmingly portray the mentally ill as dangerous.

At this point, it is unknown whether the shooter in Connecticut, Adam Lanza, is diagnosed with or was treated for any mental illness. Some reports have speculated that he may have Asperger’s syndrome, a form of autism. But scientific experts agree that Asperger’s is not correlated with violent behavior.

– Greg Noth

Since last Friday’s mass shooting at Sandy Hook Elementary School in Newtown, CT, the media coverage has largely concentrated on gun control policies and America’s ongoing inability to address mental health issues. While the image of twenty dead children makes the effects of gun violence vividly tangible, it doesn’t reveal the full extent of the costs of what some might argue has become an American epidemic.

According to a Centers for Disease Control (CDC) study, nonfatal gun injuries and gun-related deaths cost the United States $5.6 billion in medical spending every year, and an additional $64.6 billion when accounting for the lost productivity that stems from gun-related violence:

Worse still, victims of gun violence tend to be concentrated in urban and inner-city regions — the types of Americans who are less likely to be employed or have health insurance, and more likely to pass the cost of their care onto other Americans by relying on emergency room services.

Although the number of gun-related deaths has been lowered thanks to breakthroughs in medical technology, the actual incidence of gun-related violence has actually been increasing.

Following last week’s tragic shooting in Newtown, CT, tens of thousands of Americans have signed their names to a petition calling on the White House to “produce legislation that limits access to guns.” Some lifelong gun advocates have even begun to reconsider their stances and call for “common sense” gun safety policies.

Indeed, since gun regulations vary across states, some states currently impose harsher restrictions on getting a driver’s license, qualifying for food stamp assistance, accessing medical services, or even buying a pet than they do for purchasing a gun. In fact, as states passed dozens of new abortion restrictions over the past year, these are just five states where it’s significantly harder to get an abortion than a gun:

1) ARIZONA: When it comes to gun regulations and restrictions, Arizona is one of the most lenient states in the country. In fact, New York Mayor Michael Bloomberg hired undercover agents last year to demonstrate just how easy it is to purchase firearms in Arizona without being subjected to a background check. But Arizona also passed one of the most restrictive abortion bans in the country, requiring women seeking abortions to undergo a 24-hour waiting period, an in-person “counseling session,” and a mandatory ultrasound. The Arizona government also recently launched a misleading website dedicated to educating women about the dangerous decision to have an abortion, even though it is a safe medical procedure.

2) MISSOURI: After state lawmakers loosened regulations for purchasing firearms in 2007, there is no longer any waiting period for gun ownership in Missouri. There’s also no limit to the number of firearms that residents can purchase at one time, and gun owners don’t have to obtain a license or register their firearms. On the other hand, women seeking abortions in Missouri have several hurdles to overcome. Women are required to wait 24 hours before they can have an abortion, make an additional visit to the clinic to receive “in-person counseling,” and confirm that they have not been coerced into the procedure. And if Missouri lawmakers have their way, it could soon be more difficult for women to obtain affordable contraception than it is for them to obtain a gun.

3) MISSISSIPPI: There’s no license or permit required to purchase a firearm in Mississippi. The state also doesn’t require any kind of firearm safety training as a prerequisite to buying or carrying a gun, and does not require handguns to meet safety standards. But while lawmakers in Mississippi may not be particularly concerned about gun safety legislation, they are worried about women’s health clinics. After state legislators passed a restrictive regulation to hold abortion clinics to unnecessary standards — an indirect method of limiting women’s reproductive freedom by targeting abortion providers — the state’s clinics were forced to stop performing the medical procedure. There’s only one abortion clinic left in the entire state of Mississippi, and it may be forced to close in January.

4) TEXAS: Texas does not require a waiting period to buy guns, but it does impose a 24-hour waiting period on women who seek abortions. Texans also don’t need a license or registration for their firearm — but women who are looking for health services rather than a gun could be out of luck, since Texas legislators have been on a crusade to defund the women’s health organizations that provide abortion services. Preventing low-income women from having access to health services at clinics that also perform abortions isn’t enough for Texas Republicans, though — they also want to prevent doctors from even talking about abortion with their patients, although discussing guns would probably be considered fair game.

5) UTAH: Utah imposes one of the harshest restrictions on women who seek abortions, requiring them to wait a full 72 hours before undergoing the procedure. The same isn’t true for purchasing guns, since there’s no waiting period whatsoever for buying a firearm. Utah lawmakers may hope that women end up changing their mind about getting abortion if they’re required to wait several days and attend an in-person “counseling session,” but studies have shown that imposing those hurdles don’t actually impact women’s decisions. On the other hand, there’s evidence to suggest that imposing waiting periods for gun ownership can be an effective safeguard mechanism to provide enough time for background checks to go through, as well as allow for a “cooling off period” in the cases where an emotional altercation may have encouraged one of the participants to obtain a weapon.

Now that President Obama has secured a second term, the implementation of his landmark health reform law continues to march forward — but since stubborn Republican governors across the country see themselves as the last roadblock standing in the way of Obamacare, they’re still doing everything in their power to halt that progress.

Last month, federal officials agreed to give state officials more time to design their health exchange markets in light of Republican leaders’ concerns that they wouldn’t be able to turn in their plans in time. However, as GOP governors continue to resist Obamacare as a purely political statement, Politico reports that they have allowed deadlines to come and go without lifting a finger to do the necessary work to prepare for the impending health care law:

The passive resistance of so many governors could gum up the works if the feds have to handle millions of enrollments, questions from confused customers and greater health plan oversight.

As of Friday — the final deadline for states to declare whether they’ll set up exchanges — more than 30 states had refused to set up the marketplaces, which had been expected to become the source of health coverage for as many as 25 million people by the end of the decade. To some of the law’s most vocal opponents, that’s a pretty good way to keep up the fight against Obamacare.

“The more states that opt out of the state-based exchanges, the harder it will be for the federal government to fully implement Obamacare and the more likely it will be that we can turn back the clock and reframe the health care debate,” Tea Party Patriots wrote to supporters ahead of Friday’s deadline.

Some Republican governors say they’re dragging their feet on reform because they still haven’t had enough time to prepare, or because they need more information from the Obama administration to fully understand what’s expected of them. In the lead up to last week’s deadline, several of the Republican governors who have been particularly resistant to cooperating with Obamacare’s implementation — including Florida Gov. Rick Scott, Louisiana Gov. Bobby Jindal, and Arizona Gov. Jan Brewer – requested a meeting with Obama to talk over the details of the Affordable Care Act’s impact on their states.

But Democratic lawmakers dismiss these concerns as simply a convenient excuse for standing in the way of Obamacare, pointing out that Republican leaders have had plenty of time to complete their homework. “It seems to me it’s just the latest attempt to undo the Affordable Care Act,” Rep. Henry Waxman (D-CA) told the Hill. “Let’s not buy into this next line of attack that the law must be delayed.”

Despite what Obamacare opponents may hope, however, the Republican governors refusing to do the work to prepare for Obamacare in their states won’t actually prevent the health reform law from going into effect. The Obama administration maintains that the health exchanges will be ready in time — even if more of the responsibility for them rests with the federal government rather than with state officials.

In the wake of the tragic shooting in an elementary school in Newtown, CT, Americans are engaged in a renewed discussion about how to prevent future mass shootings. But while some lawmakers are working toward legislative solutions to prevent gun violence, Gov. Bob McDonnell (R-VA) is proposing a new budget that could undermine that goal.

McDonnell is proposing a mix of spending increases and cuts to Virginia’s two-year budget that would slash nearly $60 million to state agencies — and, as the Washington Post reports, some of those cuts come from sources many Americans might prefer to be well-funded. Even though the events in Newtown have put mental illness back in the national spotlight, McDonnell seeks to cut $1.5 million from Virginia’s mental health facilities, and looks to save an additional $7 million by closing a juvenile correction facility in the state.

Mental health services remain largely underfunded across the country, as many states like Virginia seek to tighten their budgets to compensate for the rising costs of health care. Only about 7 percent of Americans currently receive some type of mental health treatment, potentially because they can be difficult to afford — mental illness tends to disproportionately impact low-income Americans, but treatment carries high out-of-pocket costs.

Luckily, Obamacare may help improve Americans’ access to mental health treatment, since federal officials do recommend that all states offer coverage for mental health services in the health insurance exchanges they will operate under the health reform law. McDonnell, however, remains a staunch opponent of Obamacare and has refused to work toward setting up a state-level exchange in Virginia.

Fox News Host and former Governor Mike Huckabee (R-AR) doubled down on his claim that the murder spree in Connecticut was caused by removing God from schools, linking the shootings to “tax-funded abortion pills” and society calling “sinful” acts “normal.” Speaking on Fox News on Saturday, Huckabee suggested we should not be surprised “that a culture without [God] reflects what it has become:”

Christian-owned businesses are told to surrender their values under the edict of government orders to provide tax-funded abortion pills. We carefully and intentionally stop saying things are sinful and we call them disorders. Sometimes, we even say they’re normal. And to get to where we have to abandon bed rock moral truths, then we ask “well, where was God?” And I respond that, as I see it, we’ve escorted him out of our culture and marched him off the public square and then we express our surprise that a culture without him reflects what it’s become.

Watch it:

In reality, there are no “government-funded abortion pills.” The Obamacare contraception mandate, which is what Huckabee is likely referring to, does not provide coverage for any abortifacients — and will actually help reduce abortion rates.