Last Friday, the U.S. Department of Health and Human Services (HHS) announced that it would allow states to pursue waivers letting them privatize their Medicaid expansions under Obamacare — an idea that took root with a deal worked out by Arkansas Gov. Mike Beebe (D) and the Obama HHS last month. Commentators and policy-makers heralded it as a “game-changer” for the reform law, as it could influence red states — many of which have high poverty levels and massive uninsurance rates — to extend coverage to poor people and help facilitate a major Obamacare provision.

But as Medicaid policy expert and George Washington University professor Sarah Rosenbaum smartly pointed out to the Washington Post’s Sarah Kliff in March, using federal dollars to put Medicaid-eligible populations into privately-contracted plans isn’t a novel concept at all — to the contrary, states have actually been doing it for decades through their increasing use of Medicaid managed care (MMC) arrangements. These arrangements contract beneficiaries’ care out to private insurers and providers, and a full “two-thirds of Medicaid enrollees now receive most or all of their benefits in managed care.”

Republicans have historically been strong proponents of MMC, touting its potential to cut costs while protecting poor Americans’ benefits. But with HHS’s new offer to institute a wide-scale version of this program now on the table, several notable Republicans are balking at the idea — including some who have pushed for similar measures themselves in the recent past:

1. TEXAS GOV. RICK PERRY. The 2012 presidential aspirant has been on an anti-Medicaid bender of sorts lately, declaring that “Texas will not be held hostage by the Obama administration’s attempt to force us into the fool’s errand of adding more than a million Texans to a broken system.” Yet, during his presidential run in late 2011, Perry struck a massive deal with federal officials allowing him to move close to a million Medicaid beneficiaries into managed care. Perry heralded the move in a press release, saying, “By approving Texas’ Healthcare Transformation and Quality Improvement Program Waiver, state and local officials can provide more efficient and effective care, and implement locally-tailored health solutions.” Apparently, Perry doesn’t view the Obama Administration’s offer on privatized Medicaid to be a similar opportunity for implementing “locally-tailored” solutions.

2. LOUISIANA GOV. BOBBY JINDAL. One of Obamacare’s most ardent critics, Jindal has steadfastly refused to expand Medicaid in his low-income state, saying that “Medicaid still operates under a 1960s model of medicine with inflexible, one-size-fits-all benefits and little consumer engagement and responsibility.” So far, he has stuck by that decision despite the urging of local lawmakers and his own state’s hospital chains. But back in 2011, Jindal aggressively — and successfully — pushed through an expansion of Louisiana’s MMC program, shifting 900,000 Medicaid and CHIP beneficiaries onto private, managed care. The measure was actually Jindal’s number one health care-related priority for 2012, and his administration publicly sold it “as a way to save taxpayer money and provide better care through coordination among doctors, hospitals and other medical professionals.”

3. MISSISSIPPI GOV. PHIL BRYANT. In an interview with Kaiser Health News, the Mississippi governor said, “I would rather pay extra to Blue Cross [to help cover uncompensated costs for the uninsured], rather than have to raise taxes to pay for additional Medicaid recipients” — a tacit endorsement of a managed care scheme. In fact, in 2012, Bryant signed a bill allowing Mississippi’s Medicaid division to increase the proportion of beneficiaries who could be placed onto managed care programs from 15 percent to 45 percent of the aggregate pool. Bryant has attributed his opposition to Medicaid expansion to his view that the program disincentivizes people “to find a better job, or to go back to school, or to get [into] a workforce training program.”

Mississippi, one of the poorest states in the nation, is grappling with what to do about its Medicaid program. A deeply red state where the GOP controls both state houses and the governor’s mansion, Mississippi lawmakers are highly skeptical of Obamacare’s optional Medicaid expansion. So, in a last-ditch effort to protect the state’s low-income residents — as well as the fiscal security of the safety net hospitals that serve them — Democrats in the state senate sent Gov. Phil Bryant (R) a letter expressing their wish to introduce legislation that would automatically trigger a Medicaid expansion if Mississippi’s disproportionate share hospitals (DSHs) buckle under the weight of the payment cuts contained in Obamacare. Unfortunately, Bryant’s initial response to the proposal suggests he doesn’t fully understand the dire consequences awaiting his state’s safety net hospitals without an expansion of Medicaid.

For some context: as part of Obamacare’s efforts to make a dent in government health expenditures, the law contained some pretty deep cuts to so-called “DSH payments” — federal reimbursements to safety net hospitals that cater mostly to the poor and uninsured. Such hospitals need these reimbursements since their patients usually can’t afford the full cost of their care, and the DSH payments help make up for their resulting high uncompensated care costs. But Obamacare cuts these payments in half by the year 2019. The reason? When lawmakers first passed the reform law, they were working under the assumption that its Medicaid expansion would be mandatory, and that an influx of newly-insured Americans on Medicaid would reduce the federal government’s need to dole out DSH payments.

Of course, the Supreme Court ultimately rendered the Medicaid expansion optional and left it to states’ individual discretion. That threw a pretty big wrench into the Obama Administration’s plans, and is a large part of the reason the Administration has been begging states to grow their Medicaid pools; it’s also a large part of the reason that GOP governors in highly uninsured states like Arizona and Florida have embraced expansion, giving into pressure from hospital associations warning that they can’t afford to keep treating poor and uninsured Americans in the face of DSH payment cuts. But Bryant is betting that the federal government won’t actually follow through on the DSH cuts because they would violate the Supreme Court’s ruling that states cannot be “punished” for not expanding Medicaid:

“Without disproportionate share payments, many rural hospitals and hospitals that treat a disproportionate share of uninsured Mississippians will close,” Sen. David Blount, D-Jackson, said during a news conference that two dozen Democrats had in the Capitol rotunda. “People will lose jobs and people will lose access to health care, particularly in our rural communities.”

Bryant said in an interview a short time later he doesn’t believe the federal government will eliminate disproportionate share payments.

“We believe that they would be in violation of the United States Supreme Court decision, which said you can’t punish a state for not expanding Medicaid. And they certainly would be punishing us by doing that. So, I don’t think that ought to be a trigger,” Bryant told reporters in an office next to the House chamber, where he’d been having closed-door meetings with Republican lawmakers.

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Mississippi’s only remaining abortion clinic, the Jackson Women’s Health Organization, is struggling to stay open as it is faced with unnecessary, complicated restrictions imposed by the state’s Republican lawmakers. But its owners are staying positive — and they hope to send that positive message to the rest of the Jackson community, now that the clinic building has gotten a new, bright pink facelift:

The Jackson Women’s Health Organization over the weekend painted its one-story structure on the corner of State Street and Fondren Place in a vibrant, cheery hue. It’s in contrast to the dark shadow of legal woes that has plagued its operations since last year, when the state passed a law threatening its closure.

“It’s a woman’s color,” said clinic Owner Diane Derzis. “It says, ‘We’re right here, and we’re not going anywhere.’”

Since the paint job, the clinic has fielded numerous calls and heard dozens of comments from people saying they like it, according to clinic Director Shannon Brewer, who said the public reaction has surprised even clinic staff.

But since the Jackson clinic hasn’t been able to comply with the restrictive regulations — the new rules require the clinic’s doctors to secure hospital admitting privileges, but all seven hospitals in the surrounding area have so far denied them — it may be in trouble soon. On Thursday, the clinic received its first official notice that the state intends to revoke its operating license, although the women’s health organization will be able to remain open while it awaits a state hearing on the matter.

Anti-choice advocates claim they’re simply concerned about making sure clinics are safe. But at a closed-door event with abortion opponents earlier this month, Mississippi’s own governor revealed the GOP’s true intentions behind over-regulating the Jackson Women’s Health Organization. “My goal of course is to shut it down,” Gov. Phil Bryant (R) said. But it’s not going anywhere without a fight.

In an interview with Kaiser Health News on Wednesday, Mississippi Gov. Phil Bryant (R) explained he remains a staunch opponent of Obamacare because health care reform is unnecessary. According to Bryant, every single American already has the health care they need.

In order to justify his continued refusal to expand his state’s Medicaid program — which would extend health coverage to an additional 200,000 low-income Mississippians — the governor explained that poor people don’t need a “massive new program” when they can simply visit an emergency room to receive care:

BRYANT: There is no one who doesn’t have health care in America. No one. Now, they may end up going to the emergency room. There are better ways to deal with people that need health care than this massive new program.

This is not a new train of thought in the Republican Party. During the presidential election, GOP candidate Mitt Romney claimed that “we do provide care for people who don’t have insurance” by picking them up in ambulance and taking them to the hospital. But suggesting that uninsured Americans can simply get the care they need in the ER is naive. Emergency room and ambulatory care are some of the most expensive medical services in the industry, and the current health care safety net isn’t able to accommodate the strain of an influx of uninsured, low-income Americans who can’t foot those bills.

And, of course, Bryant’s assertion that “there is no one” who lacks health care in this country is false. The Census Bureau estimates that nearly 49 million people were uninsured in 2011. Over 20 percent of working Americans don’t have health care, and 40 percent of the people living in poverty were unable to visit a doctor in 2010. Some of the country’s poorest residents are currently unable to qualify for Medicaid coverage — and even when they do, they can still struggle to access the health services they need.

Obamacare makes big strides to improve Americans’ access to care, particularly with its optional Medicaid expansion, which could extend coverage to 17 million previously uninsured low-income people across the country. But if Republican leaders like Bryant — whose own state has a 19 percent uninsurance rate, one of the worst in the nation — continue to oppose health care reform by pretending uninsured Americans don’t exist, that progress will be placed in jeopardy.

Today marks the deadline for Mississippi’s sole remaining abortion clinic, the Jackson Women’s Health Organization, to comply with the restrictive, unnecessary restrictions that the state’s Republican legislators imposed last summer. The new regulations require the clinic’s doctors to secure hospital admitting privileges, but all seven hospitals in the surrounding area have so far denied them. A Bush-appointed federal judge temporarily blocked the law to give the doctors more time to secure the privileges they need, but that order expires today.

In public, anti-choice advocates claim they support enacting additional regulations for abortion clinics as an important measure to protect women’s health and safety. But when Mississippi Gov. Phil Bryant (R) attended an anti-abortion event on Thursday, he didn’t feel the need the sugarcoat his real motives for signing the restrictive measure into law last year:

“My goal of course is to shut it down,” Gov. Phil Bryant said after addressing a group of pastors attending a pro-life luncheon Thursday in Jackson.

The governor doesn’t have that authority. Instead, by Friday lawyers representing the state must file a response in federal court to a motion by the Jackson Women’s Health Organization.

Bryant himself doesn’t have the authority to ensure that women in Mississippi are forced to go without a single abortion clinic, but he certainly can move closer to his goal by imposing “Targeted Regulation of Abortion Providers” (TRAP) laws with the sole intention of indirectly restricting women’s reproductive rights. TRAP laws have been a successful method of targeting abortion providers in other states, since clinics are often forced to close when they are unable to meet the complicated new standards.

Bryant isn’t the first politician to suggest that TRAP laws are nothing more than a politicized attack on women’s constitutional right to an abortion. After Virginia imposed similar restrictions on its abortion clinics last year, the state’s health commissioner saw right through them — and resigned in protest of the Virginia Board of Health’s anti-choice agenda.

Unfortunately for the women of Mississippi, Bryant’s move toward accomplishing his goal could have dire consequences for them. The state already has high rates of teen and unintended pregnancy, statistics that Bryant chooses to blame on teenagers rather than accept responsibility for his own policies that promote ineffective, medically inaccurate abstinence education in schools.

Even though the increased numbers of young women using effective forms of birth control have contributed to a steady decline in the teen birth rate over the past decade, Mississippi has retained the highest rate of teenage pregnancy in the nation. At an event this week to address the issue of unintended pregnancy in the state, Gov. Phil Bryant (R) told reporters he believes that although most adolescents do know how to obtain and use contraception, “the problem is teenagers do not care enough” about using birth control.

The GOP governor cited an education campaign that his administration sponsored this year as an example of the steps he’s taking to address the problem:

Bryant appointed a group earlier this year to study ways to reduce teenage pregnancy, and it has also sponsored town-hall meetings in Jackson and Lexington. The group has posted several billboards around the state with a photo of a pregnant belly, complete with stretch marks, next to the slogan: “Scars may fade. A baby is FOREVER.” [...]

Bryant told The Daily Leader that town-hall meetings to discuss teen pregnancy are important. “The road to success is in having an open, frank discussion and saying we need to stop this,” Bryant said.

Bryant has said repeatedly that he believes abstinence-only is the best approach to teaching young people about sex. It’s the approach that’s been used for years by the school districts that already were teaching optional classes about sex education.

In fact, Bryant’s approach to reducing the number of unintended pregnancies in his state is directly contradictory. Even though he claims Mississippi’s high teen pregnancy rate is not due to a lack of education about birth control, and rather a disregard for using it, the reality is that many teens choose to forgo contraception because they are grossly misinformed about how effective it is. According to the Centers for Disease Control, about one third of teen mothers decided not to use birth control when they became sexually active because they just didn’t believe they could get pregnant.

And that lack of education about effective contraception is a direct result of the abstinence-only education programs that Bryant supports. Studies have confirmed that when students aren’t given comprehensive, medically accurate information about how to prevent pregnancy and sexually transmitted diseases, they end up with serious gaps in their sexual education.

A 2011 Mississippi state law requires that some kind of gender-separated sexual education must be offered in public schools, but the school districts are split between providing abstinence-only education classes and “abstinence plus” classes that — while still primarily pushing shame-based abstinence messages — include some mention about some forms of contraception. Even though Bryant’s billboards may be trying to tell teenagers that babies are “forever,” young adults won’t start getting the message about effectively preventing unintended pregnancy until they receive medically accurate information about it.