California Gov. Jerry Brown (D)

Under the ruling — which the Brown Administration will appeal — California will have to submit a plan outlining how it proposes to reach safe inmate population levels within 21 days. The decision expands on another judge’s ruling last week that court oversight of California prison health care should not end considering the state’s inability to provide inmates with appropriate mental health care due to overcrowding.

The U.S. Supreme Court ruled less than two years ago that California was failing to meet constitutional standards prohibiting cruel and unusual punishment due to rampant prison overcrowding and the resulting inadequate medical services. Brown and other California officials have argued that their efforts to address the issue have been sufficient, and that they should no longer be forced by courts to meet the population standards since the problem has basically been solved:

Deborah Hoffman, a spokeswoman for the California Department of Corrections and Rehabilitation, criticized the judges’ decision in a prepared statement.

“The truth of the matter is that California has invested more than a billion dollars to transform its prison health care system into one of the best in the country,” her statement said. “Our prisons now provide timely and effective health care to inmates that far exceeds what the Constitution requires.”

Currently, the prisons hold 119,542 inmates, or 149.5% of the number they were designed to hold, according to a report released this week by the corrections department.

The jurists…have ordered the state to reduce crowding to 137.5% of capacity. About 9,500 inmates would have to be removed to meet that goal.

Contrary to Hoffman’s and the Brown Administration’s rosy views on the state of California’s prison health system, the Golden State has a horrible record of providing sufficient services to prisoners. That’s particularly significant for the medically vulnerable prison population, which is comprised of a disproportionate number of minorities and low-income Americans — 37 percent of whom have chronic diseases, 65 to 80 percent of whom have struggled with substance abuse, and 13 percent of whom suffer from severe mental illness. With state cuts to mental health funding and California’s bursting prison population, prisons have also turned into de facto asylums, perpetuating cycles of mental illness and poverty in minority populations while enshrining stigma against ex-convicts and mental patients.

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.

As states across the country impose restrictions to limit women’s access to abortion, California lawmakers are taking the opposite route. On Wednesday, Democratic lawmakers introduced legislation to expand the availability of first-trimester abortions by allowing more medical professionals — such as nurses and midwives — to perform the procedure.

Assembly Bill 154 revives last year’s push to allow nurses to perform nonsurgical abortions. Gov. Jerry Brown (D) ended up signing a watered down version of that bill, which only allowed non-doctors to perform early abortions after going through training in a specific pilot program. The California’s Nurses Association opposed the initial version of last year’s bill because they wanted to see the results from a multi-year study on early abortion that researchers were conducting at the University of California-San Francisco — but since the results from that study were published last week, lawmakers say the political landscape is different now.

The six-year study led by UCSF found that first-trimester abortions are just as safe when they are performed by professional nurses, physician assistants, and midwives as when they are performed by doctors. In a press release about their results, the researchers explained that expanding the abortion procedure beyond doctors could ultimately help eliminate the economic and racial barriers that prevent some women in California from accessing early abortions:

Nationally, 92 percent of abortions take place in the first trimester but studies find that black, uninsured and low-income women continue to have less access to this care, according to the researchers.

In California, 13 percent of women using state Medicaid insurance obtain abortions after the first trimester. Because the average cost of a second trimester abortion is substantially higher than a first trimester procedure and abortion complications increase as the pregnancy advances, shifting the population distribution of abortions to earlier gestations may result in safer, less costly care, according to the research team.

“Increasing the types of health care professionals who can provide early aspiration abortion care is one way to reduce this health care disparity,” said lead author Tracy Weitz, PhD, MPA, a UCSF associate professor and director of Advancing New Standards in Reproductive Health at the UCSF Bixby Center for Global Reproductive Health. “Policy makers can now feel confident that expanding access to care in this way is evidence-based and will promote women’s health.”

In a press conference on the 40th anniversary of Roe v. Wade to unveil the bill, California lawmakers said they are committed to ensuring that women can access reproductive care no matter where they live in the state. According to the bill’s sponsors, 52 percent of California counties don’t have an abortion provider other than hospitals, which may have limited services. “California will not go back. We are going to go forward,” said state Sen. Hannah-Beth Jackson (D).

But other states across the country are going back, as women’s access to first-trimester abortions continues to be threatened. In states like Iowa, Texas, and Wisconsin, anti-choice lawmakers are imposing unnecessary barriers to early abortion — even though restrictions on first-trimester abortions simply lead to a rise in more costly later term abortion procedures.

Of the least-insured metropolitan areas in the United States, seven of the top ten fall in states where the Governor has refused to accept the expansion of the Medicaid program offered up under Obamacare.

Texas Gov. Rick Perry (R), Florida Gov. Rick Scott (R), and Georgia Gov. Nathan Deal (R) have all said expressly that their states will not allow the expansion to take effect — despite the fact that it would offer afforable health care to citizens up to 133 percent of the poverty line who are currently uninsured and who often rely on the emergency room for their only care, racking up costs for taxpayers. But their states have some of the highest level of uninsured people overall, and are host to the least-insured American cities:

The expansion of Medicaid is actually beneficial to the states that implement it. Aside from the obvious benefit of helping more Americans stay healthy, it is projected to save states money by cutting down on the public expenses of unexpected hospital visits by sick uninsured people. And support for the expansion is wide; doctors and hospital officials believe it will hugely benefit them by taking away the burden of sudden urgent care.

The Governor of Nevada, Brian Sandoval (R), has not yet committed to expanding the Medicaid program in his state. California Gov. Jerry Brown (D), on the other hand, has indicated his state will participate in the expansion.