On Election Day 2012, Los Angeles County voters approved Measure B, an ordinance “requiring producers of adult films to obtain a County public health permit” and for “adult film performers to use condoms while engaged in sex acts.” Porn producers, who have consistently opposed the measure, vowed to fight it tooth and nail. But as it turns out, one group is ready to fight back.

On Monday, the AIDS Healthcare Foundation (AHF) — an advocacy and lobbying outfit that has pushed for cheaper HIV medications and greater public health protections for HIV-positive Americans — became the first group to call out the Los Angeles County Department of Public Health over its allegedly lax enforcement of Measure B since its passage. The foundation lodged an official complaint with the County “after receiving an anonymous letter with an accompanying videotape filmed by someone on an Immoral Productions set” depicting unsafe sex practices and reviewing material on the production company’s website that also depicted intercourse without a condom.

For the well-funded advocacy group, this is just the latest skirmish in a decade-long battle. AHF president Michael Weinstein has spearheaded efforts to instill the same workplace safety and public health standards on straight porn sets as are already enforced in most gay pornography productions. Under his leadership, the AHF filed suit — to no avail — to make Los Angeles-produced pornography a “condom-only” enterprise; pushed for a citywide L.A. ordinance to the same effect; and spent over $1.6 million in its ultimately successful 2012 campaign to pass the more expansive, countywide Measure B. As he told L.A. Weekly in 2010, “AHF doesn’t give up on an issue, and we’re not going to give up on this.”

It appears that Weinstein and his group plan to follow through on that promise in the face of a combative Los Angeles adult entertainment industry and concerns over the Public Health Department’s enforcement prowess. “We’re putting them to the test,” Weinstein told the Los Angeles Times. “If democracy means something in L.A. County — if porn producers and county supervisors are not above the law — then they will enforce it.”

AHF and fellow public health advocacy organizations certainly have their work cut out for them. Trade groups associated with the multibillion dollar L.A. porn industry have promised to litigate the measure, citing freedom of speech concerns. This argument could potentially stand up in court — but only if the industry’s claims that it sufficiently tests all of its performers for sexually transmitted infections are true. An independent study by AHF that was published in the December Journal of Sexually Transmitted Diseases presents plenty of evidence to suggest that they are not, as “roughly a third of the 168 adult film actors who participated in the research project were found to have a previously undiagnosed STD.”

The Great Recession, in conjunction with states’ propensities to cut Medicaid benefits in the face of the rising cost of health care services, led to some of the biggest cuts to state mental health care services in U.S. history between 2009 and 2011. Of course, the population of Americans with mental health problems didn’t just disappear in that time. Facing a shortage of adequate medical resources, many of them are now ending up in the only place that will take them: America’s jails.

According to CBS News, a shortage of mental health facilities and adequate treatment resources — particularly in large states like Illinois and California — has produced an untenable status quo in which the prison system serves as an alternate pipeline to funnel through sick Americans, who have nowhere else to go:

Police logs in twelve cities revealed that mental health crisis calls have increased an average of 37.5 percent over the last four years.

Los Angeles County Sheriff Lee Baca says more mentally-ill people end up in jail when they’re not getting the medications they need. [...]

”I believe it is, I think that medication is the stabilizer for most mentally-ill people,” said Baca. ”The money for that dried up with our California economy going south and when they go off their meds, they go back to the behavior that leads to a law enforcement solution.”

Kathryn Wooten of Los Angeles called 911 for help when her 23-year-old son Terrence suffered a mental breakdown in October 2011.

”The police came and I thought they were going to take him to the hospital but he wind up in county jail,” said Wooten.

Police say with few mental health beds available at state facilities, they have no choice but to leave the fate of people like Terrence Wooten to the criminal justice system.

”They have a mental ward in county but he wasn’t really getting the counseling and the therapy that he needed,” said Wooten.

To state the obvious, prisons are not treatment facilities, and guards are not professionally trained medical personnel — a fact that law enforcement authorities understand all too well. ”This is something that happens all the time here and the heart of it is, we’re not a mental health facility. These people should not be here,” said Cook County Sheriff Tom Dart. “These people by and large are not criminals. They’re people with mental illness but when they act out they end up in the jails because it’s the only place that’ll take them.”

California could serve as the poster child for what happens when slashes to mental health care funding — particularly through cuts to public insurance programs such as Medicaid — meets a sprawling industrial prison complex bursting at the seams. Patients become prisoners, reminiscent of a time when ignorance regarding mental illnesses perpetuated a system of asylums and involuntary commitment that public health advocates spent decades fighting, as it treated mentally ill Americans as dangerous vagrants to be locked up rather than patients to be cured. In fact, the mentally ill are not predisposed to violence, and are more likely to be the victims of violent acts than anything else.

But now, poor access to facilities in the face of states’ budget cuts have left the mentally ill — particularly the low-income mentally ill, who have access to even fewer resources than their wealthier counterparts — with few places to go. It’s a particularly devastating dynamic considering that states’ spending on prisons is the fastest growing budgetary item behind Medicaid. However, while Medicaid costs have risen due to the general rise of health care costs, states’ decisions to invest more in prisons in order to incarcerate — rather then rehabilitate — increasing numbers of Americans is a conscious and deliberate choice.

Celeste Greig, president of California Republican Assembly, the state’s oldest and largest GOP volunteer organization told The Bay Area News Group this week that pregnancies resulting from rape are rare “because it’s an act of violence, because the body is traumatized.”

Bizarrely, Greig made the comments while criticizing similar remarks from Todd Akin, who falsely claimed that “legitimate rape” rarely causes pregnancy since the female body “has ways of shutting that whole thing down.”

Akin lost his bid for the Senate, along with other candidates who made insensitive comments about rape in the last election cycle. However, that hasn’t stopped other members of the GOP from chiming in with similar statements this year.

In a blow to Americans relying on Medicaid — the state-federal partnership public health insurance program that covers disabled and low-income Americans — the federal government on Tuesday reaffirmed to a California federal appellate court that, in the Obama Administration’s opinion, “states could cut Medicaid payments to many doctors and other health care providers to hold down costs in the program,” paving the way for massive state health care cuts that will further discourage doctors from treating low-income patients enrolled in the program.

Doctors, health care providers, and patient advocacy groups sued California in response to state health officials’ decision to cut already-low reimbursement rates for providers that treat patients on Medi-Cal — California’s Medicaid program — by an extra 10 percent. State leaders led by Gov. Jerry Brown (D) argue that the payment cuts are necessary for California’s fiscal security, especially as the state expands Medi-Cal to an addition 1.8 million Californians under Obamacare. But critics assert that the drastic payment cuts will make treating current and prospective Medi-Cal beneficiaries anathema to California care providers:

Medicaid is one of the fastest-growing items in state budgets. Cutting payment rates saves money for states and for the federal government, which will pay most of the costs for people who become eligible for Medicaid under the new law.

Health care providers said California’s payment rates were inadequate even before the cuts. They pointed to a federal study that said, “California stands out because of its very low Medicaid payment levels.”

In an interview, Dr. Paul R. Phinney, president of the California Medical Association, a plaintiff in one of the court cases, said: “Two-thirds of doctors in California cannot afford to participate in Medicaid because the rates are so low. The problem will only get worse if rates are cut as we move more and more people into Medicaid.”

The Administration’s endorsement of the Medicaid payment cuts underscores just how badly federal officials want states to take part in Obamacare’s Medicaid expansion. Formally blessing states’ abilities to “reasonably” lower their Medicaid physician payment rates is likely a concession aimed at luring reticent governors into accepting the expansion, since it will save both states and the federal government money. But while expanding Medicaid under Obamacare is crucial for the health and financial security for millions of low-income Americans, drastically lowering hospitals’ and physicians’ Medicaid reimbursements — which are already far less generous than Medicare reimbursements — is rife with risks.

Certainly, provider cuts are preferable to cutting special Medicaid benefits for the poor and disabled that are not available on lower-tier private insurance plans, especially in a state like California that has had its fair share of problems with providing adequate services to Medi-Cal beneficiaries. But California already has 6.8 million residents on Medi-Cal, including one in three Californian children and the majority of HIV-positive Californians. Payment cuts that discourage providers from treating these Medi-Cal beneficiaries will leave millions of Americans with few facilities to go to for their care, making them dependent on either free clinics, costly emergency room care, or forcing them to travel massive distances to find an accepting provider.

Reporting on a 2012 study finding that one in three American doctors won’t take new Medicaid patients, Wonkblog’s Sarah Kliff presciently wrote that that could spell trouble for states with historically low Medicaid reimbursement rates — such as California — that also wanted to expand Medicaid, since “fewer than 60 percent of providers accept new patients in the [Medi-Cal] program.” With Brown’s new Administration-endorsed payment cuts set to hit California’s safety net providers, that number has nowhere to go but down.