In Nebraska, state lawmakers are considering updating the public school system’s sexual education standards so that each school district’s health classes will be required to meet comprehensive, medically accurate standards. As legislators debated the measure this week, one Nebraska resident testified in favor of the sex ed bill by citing her own personal story: since she doesn’t believe she was fully educated about the HIV virus, she wants to prevent other students in her state from making the same mistakes she did.

Janine Brignola urged lawmakers to ensure that Nebraska’s youth don’t grow up to be as “naive” as she was about sexually transmitted infections:

Janine Brignola grew up in a rural area near Ord, Neb., but graduated from high school in Lincoln.

Not once, said the 30-year-old who is HIV-positive, was she warned of the dangers of the virus that causes AIDS at the schools she attended.

Her peers, Brignola said, told her it was a “dirty disease” that could kill her, but she believed that only the sexually promiscuous or “junkies or prostitutes got HIV.”

“I was naive and thought Nebraska was not a place that it could happen,” she said.

That lack of information about HIV isn’t specific to Nebraska. In fact, CDC data shows that HIV infections throughout the country are most concentrated in regions where students don’t learn about the virus in school. Just 20 states mandate both sex education and HIV education, and even those states may not necessarily require health classes to adhere to basic standards to ensure scientific accuracy.

But, just as Brignola highlighted in her testimony, it’s crucial to educate adolescents about effective methods to prevent HIV — rather than feeding them shame-based messages about sexual promiscuity, as if sexual health somehow doesn’t exist outside of “junkies and prostitutes.” Public schools started teaching information about sexually transmitted infections in the 1980s, at the height of the national HIV/AIDS epidemic, but religious conservatives rolled back much of that progress under former President George W. Bush, when sex ed classes became replaced with abstinence-only programs in states across the country.

Now, the CDC worries that today’s young people aren’t getting the message on HIV. Young Americans continue to put themselves at risk for the virus, and half of HIV-positive individuals between the ages of 13 and 24 aren’t even aware they have it.

As recalcitrant Republican governors still refuse to consider expanding their state’s Medicaid programs under Obamacare — despite several studies confirming that the optional Medicaid expansion will save states money and strengthen the hospital safety net system — state lawmakers have begun to pursue creative solutions to extend Medicaid coverage to their low-income constituents.

After Gov. Rick Perry (R-TX) rejected a state-wide Medicaid expansion in Texas, several counties investigated the possibility of moving forward on their own, potentially raising the eligibility threshold for their local Medicaid rolls even if the program wasn’t able to be expanded throughout the entire state. And in Nebraska, State Sen Jeremy Nordquist (D) has taken the lead on crafting a bill to expand Nebraska’s Medicaid eligibility levels that he plans to introduce when the state legislature reconvenes in January. Even though Gov. Dave Heineman (R) remains staunchly opposed to the health care reform law and would likely veto a bill to participate in Obamacare’s Medicaid expansion, Governing reports that Nordquist wants to find a way to override his veto:

Nordquist says he believes the legislature could muster up enough votes to override Heineman’s veto. It takes 30 votes from the 49 lawmakers in the state’s unicameral legislature to overturn a governor’s veto. There will be 17 Democrats and two independents who will likely caucus with them in 2013, which means at least 11 Republicans would have to buck their national party line and support a key provision of the ACA. [...]

How will Nordquist bring them around? It’s a fiscal argument, he says. The state legislative fiscal office estimated that Nebraska will spend $123 million by 2020 on the expansion. But there will also likely be savings and new revenue. The fiscal office projected the state would save $100 million by 2020 because of the ACA provision that guarantees coverage regardless of preexisting conditions, which will eliminate the need for a state program that provides subsidies for high-risk insurance buyers. That money alone almost offsets the cost of the expansion, Nordquist notes.

And Nordquist is confident in his ability to override his governor because he’s done it before. In 2010, after Heineman vetoed a bill that would have extended prenatal care to undocumented immigrants through the state’s Children’s Health Insurance Program — claiming that Nebraska shouldn’t have to fund health care for immigrants who didn’t enter the country legally — Nordquist successfully built a coalition of 15 Democrats and 15 Republicans who voted to override Heineman’s veto. This year, Nordquist already has support from Nebraska’s Republican health committee chair, who has confirmed she will propose the bill because she supports Medicaid expansion.

Nordquist was able to wrangle bipartisan support in 2010 partly by “appealing to the pro-life beliefs of the Republicans” when making his case for extending health coverage to the Nebraska residents who need it most. That could prove be a good strategy for this legislative fight, too. National faith leaders have already urged Republican governors to expand the “pro-life” Medicaid program because “depriving struggling families of healthcare is wholly incompatible with the teachings of our faiths and the ideals of our nation.”

More than 21 million low-income Americans stand to gain health coverage under Medicaid if governors like Heineman choose to participate in Obamacare’s expansion of the program.