The growth of the oil and gas industries in North Dakota has brought an economic boom to the state in recent years — job growth in the oil and gas industry has tripled since 2007, and North Dakota’s overall population has increased 44,000 since 2008. But, as the New York Times reports, it’s also placed a massive new burden on the state’s health care system.

The new jobs have predictably led to a surge in North Dakota’s population. Combined with the unusually dangerous nature of the oil and gas industries, the explosion of new residents to North Dakota is straining the state’s hospitals to their limits. Mackenzie County in North Dakota has shouldered much of the burden with its single, one-story, sixty-year-old hospital with one emergency room. In the last three years, the hospital’s average monthly emergency room visits ballooned from 100 per month to 400:

Over all, ambulance calls in the region increased by about 59 percent from 2006 to 2011, according to Thomas R. Nehring, the director of emergency medical services for the North Dakota Health Department. The number of traumatic injuries reported in the oil patch increased 200 percent from 2007 through the first half of last year, he said.

The 12 medical facilities in western North Dakota saw their combined debt rise by 46 percent over the course of the 2011 and 2012 fiscal years, according to Darrold Bertsch, the president of the state’s Rural Health Association.

Hospitals cannot simply refuse to treat people or raise their rates. Expenses at those 12 facilities increased by 15 percent, Mr. Bertsch added, and nine of them experienced operating losses.

According to the Times report, many of the new patients for the state’s health care system are transient workers who don’t have permanent addresses or health insurance coverage. One of the biggest drivers of hospital debt there is patients providing inaccurate contact information, and then disappearing when it comes time to collect. Average paychecks in the energy sector are growing faster than elsewhere, so it’s not clear if this is an income problem or just a failure of the state’s housing infrastructure to keep up with the massive influx of new residents. Ad-hoc housing has sprung up in camps and even in Walmart parking lots across the state to compensate.

Those infrastructure problems have also created second-order problems for North Dakota’s health care. Street signs and addresses are often nowhere to be found, and paramedics can have a difficult time locating patients. The cramped housing has brought its own health problems and pests, and — as can happen when lots of human beings are thrown into close quarters — sexually transmitted diseases are also on the rise.

And the problems accompanying North Dakota’s boom are a microcosm for the oil and gas industries as a whole: Their annual fatality rate between 2003 and 2008 was 29.1 deaths per 100,000 workers — seven times the rate for all U.S. workers. A single well can require 1,500 trips by semi-trucks, tankers and standard pickups to move oil, water, sand and chemicals, and a third of the industries’ fatalities are associated with the massive amounts of motor vehicle activity. On top of that, companies often pay out rewards for low injury rates, which encourages under-reporting of workers’ compensation claims. In North Dakota itself, companies are allowed to compensate injured workers directly, prompting one lawyer to describe the situation to Grist as “the wild fucking west.”

In Mackenzie County and elsewhere, there are attempts to convoke the local government to impose a new 1-cent sales tax to finance a $55 million expansion of the hospital facility. Gov. Jack Dalrymple (R) is moving to bulk up medical training in the state with a new $68 million medical school building at the University of North Dakota, and $6 million expansion of the nursing program. But for now, the small-town practitioners are largely on their own.

Oklahoma Gov. Marry Fallin (R) has refused to accept Obamacare’s optional expansion of the Medicaid program, denying an estimated 130,000 of her low-income constituents access to health care. And the direct impact of the GOP governor’s decision is evident even within her own extended family.

Fallin’s aunt, 85-year-old Dorthea Copeland, runs a free health clinic in Pottawatomie County, an area of Oklahoma that has an 18 percent poverty rate and a 28 percent uninsurance rate. Copeland’s clinic provides care for the Oklahomans who fall into the coverage gap between earning too little to be able to purchase private insurance and earning too much to qualify for Medicaid assistance — the same group of people who stand to gain coverage under Obamacare’s expansion of the public program.

But since Copeland’s niece has refused to raise the Medicaid program’s eligibility level, the clinic is currently overloaded with low-income patients who don’t currently qualify for government assistance. As Oklahoma Watch reports, Copeland’s volunteer staff — who served over 850 patients last year — are now struggling to keep up with the increasing demand for health services:

On any given Thursday evening, about 20 people pitch in. But it’s not quite enough to keep up with rising demand. On this night, five people will be told they’ll need to wait at least a week to see a doctor.

“It’s getting worse all the time,” says Ty Johnson, who shows up every week to handle patient intake. She bustles about the crowded clinic with a clipboard, calling out names and handing out paperwork. “We’re getting more and more people.”

Not everyone makes the cut. To qualify, patients must be Pottawatomie County residents, must have no other form of insurance coverage and must fall below income caps that are considerably lower than those contained in the Obama expansion plan.

“There is just more need than we can handle,” says Stephanie Scrutchins, who determines eligibility.

Under Oklahoma’s current law, families can’t get Medicaid coverage unless they have dependent children and their annual income falls below $6,996 for a family of four — one of the lowest eligibility thresholds in the nation. The health law seeks to expand the program to include families of four earning up to $30,656 each year. But Fallin says it would be too costly to add additional low-income residents to her state’s Medicaid rolls, despite the fact that outside reports estimate expanding Medicaid would actually save Oklahoma nearly $48 million per year.

When Oklahoma Watch asked Copeland what she thought about her niece’s decision to reject the Medicaid expansion, she didn’t comment. “You know, I don’t get into politics,” she said. “I just run my little business here. Hopefully, we’ll do all that we can for the people that come in. Right now I’m looking at all the returns I’ve got for next Thursday night, wondering how in the world we’ll get them done.”

With comprehensive immigration reform in the national spotlight this week, one talking point already being parroted by reform critics is that any overhaul that incorporates a pathway to citizenship for undocumented immigrants will eventually make President Obama’s landmark health care law much more expensive by adding millions of low-income immigrants onto Medicaid rolls or making them eligible for Obamacare’s private insurance subsidies. But don’t buy the hype — having these prospective Americans insured and paying into America’s tax and health care systems will be good for public health, personal health care costs, and — consequently — overall spending on health care entitlements.

The fact is, undocumented immigrants already receive subsidized care under Medicaid — but only for life-saving emergency room procedures. Those treatments are much more expensive than the primary and preventative care services that undocumented immigrants tend not to seek due to a lack of coverage, and forgoing that preventative care leads to a snowball effect in which undocumented immigrants only pursue “sick care” rather than health care, which raises health care costs for everybody by producing a more unhealthy population whose care is actually subsidized by the rest of the country.

Studies have estimated that America’s 11 million undocumented immigrants cost federal and state governments $10.7 billion in annual health care expenditures. While there isn’t an abundance of solid data on how much those costs would be lowered by placing the immigrants onto actual insurance rolls with comprehensive coverage, chances are that it would mirror trends in general health care spending on the insured versus the uninsured. Public safety net hospitals have estimated that states that do not participate in Obamacare’s Medicaid expansion will cost them over $50 billion by 2019, since uninsured and under-insured Americans cannot afford to compensate hospitals for the care they receive — and that shortfall is ultimately shifted onto the American taxpayer. Having these consumers become legal residents would allow them to pay into the system and actually pay for the benefits that they receive.

Immigration reform and a pathway to citizenship would also bode well for Obamacare’s subsidies and future Medicare spending. Bringing undocumented immigrants into the legal tax system would raise about $5 billion in new revenue in just three years — and potions of those revenues would go towards funding immigrants’ Medicare, Social Security, and Obamacare’s insurance subsidies. Furthermore, there is overwhelming evidence that people who receive quality health care and preventative services early on in life enjoy greater health — and therefore lower health care costs — in their twilight years. That’s especially significant considering that the bulk of expensive medical spending occurs in the last years of a person’s life.

At the end of the day, adding more legal immigrants and — eventually — American citizens onto Medicare, Medicaid, and Obamacare’s insurance subsidies will temporarily expand health care spending. But it also addresses the actual roots of health care inflation — namely, that people do not pursue enough preventative care early on in their lives and thus raise their treatment costs later on, and that many poor and uninsured people cannot compensate doctors and hospitals for the emergency care that they receive. By patching those elements of the social safety net, comprehensive immigration reform would actually lower long-term health care costs in America, and strengthen the social safety net.

A bill recently introduced in the Texas state house aims to reward employers who violate Obamacare, offering subsidies to any company that uses religious objection as an excuse for denying its employees copay-free contraception.

House Bill 649, introduced by state Rep. Jonathan Stickland (R), was apparently inspired by the controversy over craft chain store Hobby Lobby. That store sued to deny its employees contraception coverage, citing its male president’s religious objections. But since Hobby Lobby, and companies like it, will be forced to pay a fine for violating the law, Strickland wants to compensate them with tax breaks:

The tax credit would be limited to the amount of a federal fine that the company pays or the amount of state tax the company owes.

“When a business is being stressed nearly to the point of bankruptcy by punitive federal taxes, of course the state should give them relief,” Stickland said in the news release.[...]

“The Obama administration’s mandate and their threats to bury Hobby Lobby with $1.3 million per day in tax penalties aren’t just unconstitutional, they’re unconscionable,” he said. “It is simply appalling that any business owner should have to choose between violating their religious convictions and watching their business be strangled by the strong arm of Federal mandates and taxation.”

By offering to help compensate these companies, Strickland is accepting a drastic cut in funding to the Texas government. His plan proposes letting organizations like Hobby Lobby off the hook for state taxes up to the amount they owe in federal penalties. Since Hobby Lobby is estimated to owe a fine of $1.3 million a day (more, in a year, than it would be paying in state taxes), Hobby Lobby would get a pass on giving a single cent to the state of Texas.

But more importantly, it’s unlikely that this bill would survive if it went to the courts. Federal law does not simply supersede conflicting state law, it also invalidates state laws that “stand… as an obstacle to the accomplishment and execution of the full purposes and objectives of Congress” — a doctrine known as “obstacle preemption.” Since the entire point of this Texas bill is to thwart a federal law, it would likely run afoul of this obstacle preemption.

When anti-choice lawmakers in Wisconsin imposed unnecessary restrictions on medication-induced abortions, they claimed they wanted to make sure the procedure was safe. But now that women in the state can’t access the abortion pill to terminate a pregnancy within the first trimester, they’re being forced to delay the procedure until they can receive a more invasive surgical abortion — which can actually slightly increase the health risks for some patients, in addition to putting women through the strain of being denied the right to terminate a pregnancy when and where they would prefer to do so.

Of course, surgical abortions are still an extremely safe medical procedure. But in Wisconsin, they require a more involved process than medicine-induced abortions, forcing women to make several trips to a doctor’s office and denying her the opportunity to choose where she would prefer to terminate her pregnancy.

That’s exactly what happened to Samantha, a Milwaukee-based woman withholding her last name to protect her privacy. As the Wisconsin Center for Investigative Journalism reports, the state’s new law prevented Samantha from accessing the RU-486 abortion pill in the privacy of her own home — and ultimately made the experience a more emotionally stressful one than it would have been otherwise:

Samantha later learned that state lawmakers were planning to change the rules for medication abortions, which could make it more difficult to obtain follow-up care.

“That was really scary,” said Samantha, who decided to wait several weeks to have a surgical abortion as she juggled work and school. She was fatigued and depressed. [...]

Samantha said that in addition to a medication abortion being available earlier, the procedure would have afforded more privacy. During her surgical abortion, she said, there were “six other people in the room,” including medical students.

“It was really overwhelming and obviously painful, too,” she said. “I really wish I could have had the privacy of being in my own room and dealing with just the people affected, just me and my partner.”

Nicole Safar, the public policy director for Planned Parenthood Advocates of Wisconsin, explains that many women do prefer earlier, medication-induced abortions for the privacy they offer. “More than the physical piece, for many women medication abortion is the right choice for her entire self — emotionally, psychologically,” Safar told the Wisconsin Center for Investigative Journalism. “Many women would prefer to go through the process at home, with their family. That’s a huge piece of it you can’t really quantify.”

But since the state law took effect in April, Planned Parenthood clinics across the state haven’t been able to offer medication abortions to their patients — which means that countless women like Samantha are being forced to either have a surgical abortion or travel across state lines to obtain the abortion pill. The women’s health organization is suing the state to overturn the law and restore women’s access to medicine-induced first-trimester abortions.

Making the RU-486 pill widely available has been proven to effectively lower the rate of later-term abortions, since it allows women to make their reproductive decisions as soon as possible. Nevertheless, anti-choice lawmakers insist on imposing unnecessary restrictions on medication abortion and the medical professionals who administer it, even at the expense of women’s privacy and emotional well-being.

This past weekend, Sen. Tom Harkin (D-IA) announced he will not seek re-election in 2014, bringing an almost 40 year career in Congress to a close. But as Harkin steps aside, his legacy — particularly his work to champion increased protections for Americans living with disabilities — remains.

Twenty two years ago, President George H.W. Bush signed the Americans with Disabilities Act (ADA) and the Individuals with Disabilities Education Act (IDEA) into law. Either law would have been considered landmark civil rights legislation on its own merits — taken together, they represented nothing short of a legislative revolution for disabled and special needs Americans. And those bills were made possible by Harkin, who authored and shepherded them to overwhelming bipartisan approval.

Every handicapped spot in a parking lot, each mechanical wheelchair ramp on a public transport vehicle, and any company that employs qualified Americans with a disability, is only made possible because of the ADA. The law’s provisions — which include protections ranging from anti-workplace discrimination, to public transport and public facility accommodations, to telecommunications support for the visually and hearing impaired — have given millions of Americans the means to pursue independent livelihoods. As one disabled American put it, “I have traveled 18,000 miles between Los Angeles and Bakersfield in an externship, and without the ADA and the Department of Transportation’s provisions, I would not have managed to remain independent and commute.” According to one study, the percentage of disabled Americans citing public transport accommodations as a barrier to their commute dropped from 49 percent to 31 percent between 1989 and 2004.

IDEA applied these same principles to disabled children in the public school system, establishing early intervention and special education requirements for all schools in states accepting federal funding under the statute, as all 50 states now do. And although the concept of providing proper educational facilities and services for Americans with disabilities is now considered an obvious obligation of the American safety net, before IDEA and its precursor law — the Education for All Handicapped Children Act — most of the 6 million disabled American children did not have access to an effective public education.

Granted, not all legislative efforts to assist America’s disabled have enjoyed the successes of the ADA and IDEA. Since many of Medicaid’s benefits for disabled Americans are considered “optional,” they are often a target for austerity measures and deficit reduction. And a recent effort to ratify a United Nations treaty based largely on the ADA was defeated by Senate Republicans, despite widespread support and a last minute lobbying effort by former Republican presidential nominee Bob Dole.

But Sen. Harkin deserves an enormous amount of credit for the myriad opportunities and independence that the ADA and IDEA have afforded to disabled and handicapped Americans — the freedom to pursue an education, a career, and to effectively navigate the country, rather than be relegated to an institution or permanent home care. Harkin pushed the bill to an outsized victory despite the protestations of business groups such as the U.S. Chamber of Commerce, who claimed that the law would be a “job killer” and cost entirely too much money for potentially little benefit. As the Iowa senator winds down his career, he can be assured that the legislation he pioneered during his time in office will go down in history.

New Mexico Rep. Cathrynn Brown (R) made headlines this past week when she introduced a bill to charge women who become pregnant from rape with “tampering with evidence” if they choose to have an abortion. Brown has since clarified that House Bill 206 isn’t intended to target victims of sexual assault, and has worked to revise the language of the legislation — but although she wants to ensure rape survivors won’t be prosecuted for getting an abortion, she hasn’t extended the same protections for the doctors who perform those abortions.

As the Democratic Party of New Mexico pointed out in an official statement about HB 206, the revised bill still represents a dangerous step toward criminalizing abortion. “The bill still makes it a crime to ‘facilitate’ an abortion for a woman who wants one,” Scott Forrester, the director of the group, explained. “That means doctors, nurses, or anyone else who works at a health care clinic where this is one of the services provided would still be guilty of a felony.”

Targeting abortion providers is simply an indirect method of limiting women’s reproductive access, and it has been a successful tactic for anti-choice lawmakers across the country. Abortion opponents often subject abortion clinics and providers to burdensome regulations that aren’t placed on other medical professionals — and doctors who break those rules are typically faced with harsh consequences, like losing their medical licenses.

Brown isn’t the first GOP lawmaker to go as far as to suggest that doctors who perform abortions should be subject to criminal charges. But singling out the doctors who work in this field is having serious consequences. Partly due to the obstacles placed in front of the medical professionals who perform abortions, as well as rising levels of anti-abortion harassment, the country currently has a shortage of abortion doctors — particularly in states that are especially hostile to abortion rights, like New Mexico.