Investor services and credit rating agency Moody’s has some news for GOP governors hesitant to expand their state Medicaid programs under Obamacare: either hospitals in states refusing the expansion, or the states themselves, will feel pressure on their credit ratings due to higher uncompensated care costs and cash-strapped budgets.

In a press release regarding a new Moody’s report on Medicaid expansion, the agency explains that refusing the expansion would by necessity force one of these institutions or the other to lose out — since the resulting increase in the ranks of uninsured, low-income Americans would put fiscal strains on safety net hospitals or the state at large. As Nicole Johnson, a Senior Vice President at Moody’s, explained, “States that opt out of Medicaid expansion will have to choose whether to compensate for the shortfalls with their own funds or leave hospitals to absorb the costs, which will increase rating pressure on the hospitals. States that choose to fund uncompensated care costs themselves could face budgetary strain.”

As the press release notes, refusing to expand Medicaid would significantly increase uncompensated care costs for hospitals that cater to low-income Americans because Obamacare institutes deep cuts to reimbursements made to these “disproportionate share hospitals,” or DSHs. This is because lawmakers originally expected the expansion to be mandatory for all states, thus lowering the need for DSH payments — but the Supreme Court ruled that provision to be optional, instead.

Moody’s has consistently argued that Obamacare is a good deal for hospitals and states. In fact, before the Supreme Court had issued its ruling on Obamacare, Moody’s released a statement saying that “the best possible outcome from the Supreme Court would be a full confirmation of the law” because that would be “credit neutral.” They also warned that possible hits to credit ratings would not just be limited to safety net hospitals, because, “With fewer people covered by healthcare insurance, for-profit hospitals will face increased bad-debt exposure and reduced reimbursement rates.”

Now, in their latest report, the agency asserts that the negative effects of refusing to expand Medicaid “will be greatest in states that opt out of Medicaid expansion, but have a relatively high proportion of uninsured residents.” That describes many states led by GOP governors, who have recently been coming to embrace the expansion after intense lobbying by advocates for the poor and hospital associations that are concerned about these very uncompensated care costs. But many of these GOP governors face an uphill battle against members of their own party when it comes to expanding Medicaid.

Senate Minority Leader Mitch McConnell repeated the siren call that Republicans are not going to give up on repealing Obamacare.

But in the same speech at the Conservative Political Action Conference, McConnell admitted there is little plausibility to the idea, since Republicans have already lost. “When it came to Obamacare, we gave it everything we have, everything we have, and we just lost.”

McConnell explained that won’t stop Republicans, in a speech where he assured his audience that the GOP is not stuck in the past:

This law is a disaster. Anyone who thinks we’ve moved beyond it is dead wrong. Obamacare should be repealed root and branch. We’re not backing down from this fight.

“It may not seem like it now,” McConnell concluded, “but we’re actually winning.”

Republicans are not, in fact, winning. After more than 30 votes in Congress, a Supreme Court challenge, and a presidential campaign failed to repeal the health reform law, even House Speaker John Boehner admitted “Obamacare is the law of the land.”

But many Republicans haven’t accepted that reality. Boehner’s admission earned backlash from his party, while Paul Ryan’s latest House Republican budget still assumes repeal of the law. And Tea Party favorites in the Senate still occasionally threaten to shut down the government unless Obamacare is defunded.

Earlier this month, scientists reported that they may have “functionally cured” a two-and-a-half year old child of her HIV infection by treating her with aggressive rounds of drugs as soon as she was born. They weren’t sure what that meant for adults living with HIV, since doctors may have simply prevented the transmission of the virus rather than eliminating an existing infection. But a new study suggests the same method may also work for individuals who contract HIV infections later in life.

French researchers are reporting that 14 adults have been “functionally cured” of their infections after undergoing initial treatment for HIV. The adults — just as the baby girl who was the subject of the earlier study — were aggressively treated with HIV drugs during the first two months of their infections. Now their infections are under control, and the ten men and four women in the group haven’t needed to take any HIV drugs for between four and 10 years. HIV-positive individuals are typically unable to stop undergoing HIV treatment without experiencing a “sharp and dangerous” increases in HIV replication.

Asier Sáez-Cirión, who helped analyze the findings at the Institut Pasteur in Paris, told MedPage Today that the study’s results suggest that early treatment may have some hope of “curing” HIV infections:

Although the phenomenon may not have immediate clinical implications, he said, it’s “proof of concept” that the immune system can control HIV in some circumstances.

It may also offer hope for a vaccine, he said. “It shows there is some immune response,” he said, “that can be stimulated not just to control infection but to prevent infection if that part of the immune system can be primed and activated.”

Indeed, the researchers argued that study of these patients and others like them could “open up new therapeutic perspectives” for people with HIV.

To be clear, scientists don’t know if these cases of “functional cures” will have broader implications for the 34 million people living with HIV around the world. As Sáez-Cirión points out, additional scientific research is needed to assess whether the phenomenon can be replicated on a wider scale. But it may help direct public health advocates’ energy toward effective methods of combating the virus in the very early stages of infection, and it also highlights the importance of regular testing so that newly infected individuals can become aware of their HIV status before going too long without treatment.

Here in the U.S., the CDC is focusing its efforts on expanding access to affordable HIV testing, particularly in the low-income urban areas where the virus tends to be most highly concentrated — but there’s still more work to be done, considering that about a quarter of the HIV-positive Americans aren’t aware they have the virus. Fortunately, HIV testing will be covered under Obamacare.

As of Friday, Chinese officials have pulled 8,354 rotting pig carcasses out of the Huangpu River, eliciting fears of contamination of one of Shanghai’s major water sources. The cause of this dead pig flood is still a mystery, but many of the pigs have tested positive for a porcine circovirus, which does not affect humans. It seems likely that farmers upriver dumped the pigs in the river after they fell ill or died.

China has been cracking down on sick pigs in the food supply since two massively destructive outbreaks of diseased pork put the nation on alert. Farmers will sometimes sell diseased pigs to the black market in order to recoup some of their losses. On Wednesday, 46 men were jailed for selling diseased meat. This is far from rare; as the New York Times documents, 17 people were sent to prison in December for processing and selling meat from roughly 77,000 diseased pigs. In May, 4 others were arrested for selling dead pigs to slaughterhouses.

If farmers did indeed dump the sick pigs in the river, they may have been trying to avoid similar fates. While the dead pigs do not seem to pose a serious threat to the drinking water, they may indicate China’s food safety crackdown needs redirection. The sheer number of pigs suggests they were suffering from an epidemic. Since China has no system to compensate farmers for losses from disease, they are left to cope with the aftermath in whatever way they can afford:

“There is no mechanism by which, whenever diseases are found among pigs, the government compensates pig breeders so as to control the spread of diseases or compensate pig breeders for losses,” said Feng Yonghui, general manager at pig-industry research organization Soozhu.com.

To make matters worse, Feng said insurance companies were unwilling to insure pig breeders because the risks were so high.

While authorities have not confirmed a disease, or the death of unusually large numbers of pigs, talk of pigs dying would seem to suggest an outbreak of some sort.

One farmer in the Jiaxing area near Shanghai, 69-year-old Jiang Lie, said about 30 percent of his pigs had died of disease since January.

Reuters witnesses visited three reeking swine disposal pits in Jiaxing which appeared to have been just filled up and had signs saying they were at capacity.

In order to avoid such conditions, the U.S. established a Livestock Indemnity Program (LIP) that compensates farmers if their livestock falls prey to disease or extreme weather. The program is meant to encourage farmers to report diseases to the government rather than try to pass sick animals off as healthy. Payments range from $1 for a dead duckling to $1,000 for a dead dairy bull, at 65 percent of the market rate.

However, since the 2008 Farm Bill expired, LIP and 4 other farmer compensation programs ceased to exist after October 1. Farmers who lost livestock to Hurricane Sandy at the end of October were simply instructed by the USDA to keep good records of the losses in case disaster relief funding became available. The memo states, “Production losses due to disasters occurring after Sept. 30, 2011, are not eligible for disaster program coverage.” The Senate version of the 2012 Farm Bill included these programs, but the House’s refusal to pass the bill stymied renewal. The so-called fiscal cliff deal passed in January temporarily funded some livestock assistance programs for nine months, but efforts to secure this safety net through 2018 have stalled.

Conservatives attacked the inclusion of the livestock compensation programs as “wasteful” and called for their complete elimination in the next Farm Bill. China provides a grim example of the kinds of tactics farmers may turn to if conservatives get their way.

Faced with a Veterans’ Affairs Department (VA) overwhelmed by medical claims and more and more American soldiers returning from the war in Afghanistan, the state of New Mexico has decided to provide recently-discharged veterans of the Iraq and Afghanistan wars with a critical resource: one year of free mental health services.

As per New Mexico Department of Veterans’ Services Secretary Timothy Hale, “This is the first collaborative effort between private and state agencies in the country to provide statewide pro-bono mental health counseling for Iraq and Afghanistan war veterans. This means nearly 500 veterans in the state can receive the immediate help they need now rather than waiting for any veterans’ benefits paperwork to be filled out and processed – which can take awhile to be completed.”

That’s crucial for the soldiers returning home from recent conflicts, considering that the VA has a backlog of over 900,000 unprocessed medical claims — and that’s just from current veterans. As the war in Afghanistan winds down, that problem will be exacerbated further, particularly for mental health care claims. By the VA’s own estimates, at least 15 percent of Iraq and Afghanistan war veterans suffer from Post-Traumatic Stress Syndrome (PTSD) — and that number could potentially be much higher considering the sky-high rates of suicide and homelessness among Iraq and Afghanistan veterans.

The program is being sponsored by a combination of state and federal Access To Recovery (ATR) programs, as well as local providers and nonprofits. On the webpage for the new program, New Mexico ATR specifically cites VA backlogs and waiting periods associated with claims-processing as a major reason that New Mexican veterans might want to consider the program, along with “previous failures accessing and navigating the system,” transportation barriers, and “the stigma related with mental health care.”

While the collaborative public-private partnership will relieve a major burden for New Mexican veterans by enhancing access to care and shielding them from the high costs of mental health treatment, such efforts aren’t necessarily fiscally feasible in other states. New Mexico’s ATR program — which is funded substantially through the federal Substance Abuse and Mental Health Services Administration (SAMHSA) — is one of the best in the nation, and therefore receives enhanced federal funding. So while New Mexico may be shielded from the effects of looming federal budget cuts to departments such as the SAMHSA and the VA, veterans in other states might not be so lucky.

As Republicans push the country toward draconian spending cuts, it’s important to remember the uncertainty built into the debt projections that the GOP touts to justify their policies. Health care spending is a big part of this: Medicare is one of the biggest single drivers of long-term debt, but that doesn’t necessarily mean we need to cut the program’s budget.

In fact, between 2010 and 2013, the Congressional Budget Office’s projections of how much the program would spend over the next decade dropped by $500 billion — not because lawmakers cut any spending, but simply because the growth of health care costs in the markets as a whole unexpectedly slowed after 2008. The Washington Post’s Sarah Kliff dug a chart out of the White House’s annual Economic Report of the President that drives home what a game-changer it would be if that slow-down sticks.

The blue line below represents the projection of Medicare’s spending made in the 2012 Medicare Trustees report, based on current law. The dotted orange line is Medicare’s spending if health care cost growth holds to its trend since 2008:

If the past few years turn out to be the new norm, Medicare will stay essentially flat as a share of the economy going forward. In which case, the problem of Medicare spending — and with it, much of our long-term debt problem — has already been solved. This is something CBO wouldn’t have picked up on yet, precisely because their method for projecting health care costs rests on the assumption that trends over the last two decades hold roughly steady.
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At the beginning of this year, Texas officials succeeded in their yearlong crusade to defund Planned Parenthood, a move that has forced thousands of low-income women to search for new doctors — and Republicans in the state show no signs of easing up in their obsession to block the national health organization at every turn. But, in a state where half of all pregnancies were unintended in 2011, Texas’ vendetta against Planned Parenthood has had stark consequences.

As Mother Jones details, the attacks on women’s health in the Lonestar State have made a serious, quantifiable impact. Now that Texas Republicans have left significantly fewer resources to provide low-income or uninsured women with the programs they need, this is what’s happening, by the numbers:

• Planned Parenthood provided care for nearly 50 percent of the low-income women who get Medicaid benefits through Texas’ Women’s Health Program (WHP) before anti-choice lawmakers kicked the organization out of the program.
• Thanks to the decline in state funds designated for family planning services, Texas is now funding 176 fewer health clinics than it did in 2011.
• 53 health clinics in Texas have been forced to close as a result of the budget cuts. 39 of those weren’t affiliated whatsoever with Planned Parenthood, and zero of them performed abortions.
• After health clinics began closing their doors last year, a survey of about 300 Texas women seeking abortions revealed that nearly half of those women were “unable to access the birth control that they wanted to use” in the 3 months before they became pregnant. Women cited cost barriers, lack of insurance coverage, and inability to find a clinic.
• Now that lawmakers have both cut family planning programs and defunded Planned Parenthood, 200,000 low-income women in Texas have already lost or could soon lose access to birth control, cancer screenings, and other critical preventative care.
• Because so many women are losing access to the preventative resources they need, the family planning cuts are projected to result in an additional 24,000 unplanned births between 2014 and 2015.
• Every dollar invested in family planning services leads to as much as $5.60 in Medicaid savings. On the other end of the spectrum, the increased unplanned births resulting from Texas’ cuts are expected to cost taxpayers an estimated additional $273 million in medical expenses and Medicaid coverage.

(HT: Mother Jones)

Not to be outdone by Arkansas lawmakers — who recently overrode their governor to impose a 12-week abortion ban, the strictest in the country — abortion opponents in North Dakota want to go even further.

So far this year, anti-choice lawmakers in Arkansas and North Dakota have practically tripped over each other to see which state can impose more abortion restrictions. Arkansas initially pulled into the lead by imposing two stringent restrictions, a 20-week abortion ban and, later, a stricter 12-week ban. But North Dakota may be ready to raise the stakes once again. Republican lawmakers are advancing a “fetal heartbeat” measure to outlaw the procedure after just six weeks of pregnancy, before many women even realize they’re pregnant, and they expect to have enough support to push it though:

House Bill 1456 would make it a felony for a doctor to perform a nonemergency abortion after a fetal heartbeat can be detected, which can be as early as five or six weeks. House Bill 1305 would prohibit abortions sought because a fetus has been or could be diagnosed with any genetically inherited defect, disease or disorder.

The Republican-led state Senate will vote today on the measures, said state Representative Bette Grande of Fargo, who co-sponsored the bills in the Republican-controlled House, where both have passed. Grande said she expects the Senate to approve both and the governor, also a party member, to sign them.

“The heartbeat is society’s marker for life,” Grande, a Republican, said by telephone from Fargo.

So-called “fetal heartbeat” bans are blatantly unconstitutional. Even though Roe v. Wade guarantees the right to legal abortion services until the point of viability, typically around 23 or 24 weeks of pregnancy, heartbeat bans narrow that window by as much as 17 weeks. North Dakota’s heartbeat measure will also have the unintended consequence of mandating transvaginal ultrasounds for women seeking abortions, since there’s no other way to detect a fetal heartbeat at such an early stage of pregnancy.

Unfortunately, this isn’t the only egregious affront to reproductive rights that women in North Dakota have to worry about. State lawmakers are also considering an even more radical “personhood” measure that would outlaw abortion altogether, as well as some forms of contraception. And, despite the fact that there’s just one abortion clinic left in the state, anti-choice Republicans are attempting to advance legislation that would force it to close its doors.

Testifying against the mounting abortion restrictions currently moving through the legislature, one Fargo-area doctor warned that North Dakota’s attacks on choice will ultimately force women in the state to resort to dangerous, “backroom” abortion procedures. Unfortunately, even while Roe technically still stands, North Dakota lawmakers could essentially roll back the clock to a time before women had the right to safely determine their own reproductive decisions.