The debate over Medicaid expansion has devolved into a GOP platform for grandstanding about the health reform law and the Obama administration. But an NPR article from Tuesday shines a light on what, exactly, most Republican governors’ refusal to expand Medicaid will mean for real Americans by examining poor communities in a state headed by one of Obamacare’s most ardent critics: Gov. Rick Perry (R-TX).

The piece centers on particularly destitute populations in southern Texas, where some uninsured residents are so poor, sick, and unable to cope with their medical bills that they resort to desperate measures such as crossing the border into Mexico for medications and even sharing their insulin shots:

[M]any of those who live here [in Brownsville] — including poor Latino immigrants, both legal and undocumented — suffer from diabetes and lack of insurance. Some of those uninsured diabetics, including American citizens and others living here legally, used to go across the border to Matamoros, Mexico for insulin. But now with the fear of brutal drug violence and tougher border restrictions, families share their insulin shots rather than risking the crossings.

A community health worker in Brownsville noted that “many of those who used to cross the border would qualify for Medicaid under the expansion offered by the health care law.”

This inequity is further exacerbated when dealing with a more serious or life-threatening chronic condition. One official at Brownsville’s local health clinic described how difficult it is to provide specialty care services to the poor and uninsured, emphasizing that Medicaid coverage would make it far easier to convince physicians to take on patients:

“Once you diagnose a cancer, then what?” said Dr. Henry Imperial, the clinic’s medical director. “How are you going to give me chemotherapy or surgery or radiation therapy? It goes out of our hands.”

Those complications can make for some intense arm-twisting among Brownsville’s medical ranks. Imperial said he often plies fellow doctors in town with beer to see his uninsured patients. “When they see me approaching them, they start running away,” he joked before turning somber. “It’s just tough. I could not do an appendectomy. I cannot operate on gall bladders. I need a surgeon.”

Most specialists, including surgeons, in Brownsville, accept Medicaid, said Imperial. “It does pay for services that otherwise the patient does not receive.”

GOP leaders like Perry and even some of the more serious conservative academic critics of Obamacare’s Medicaid expansion regularly cite the program’s low reimbursement rates as a reason for dismissing it. Perry has denounced expansion as doubling down on a “broken system,” since doctors won’t want anything to do with Medicaid to begin with.

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Preliminary analyses of the 2010 U.S. Census indicated that less than one in ten American seniors live in poverty. But a new and more nuanced “supplemental” poverty metric finds that number may actually be closer to one in seven seniors when accounting for their out-of-pocket medical bills.

The “original” poverty metric has been used since the 1960s. But some argue that it’s an archaic measuring stick, since health care costs and — consequently — out-of-pocket spending on medical services have exploded in the ensuing decades. That means that, despite access to relatively generous health coverage through Medicare (another 1960s-era program), seniors have been forced to pay an increasing share of their retirement income on hospital and drug bills over the last 50 years. And seniors who suffer from costly, chronic medical conditions such as cancer and Alzheimer’s are especially burdened by those escalating costs.

Since the new measure takes these contemporary expenses into account, it paints a more accurate picture of the American poverty landscape. And as a state-level analysis of the numbers by the Kaiser Family Foundation highlights, things don’t look very good:

The share of seniors living in poverty is higher in every state under the supplemental measure than under the official measure, and at least twice as high in 12 states: California, Colorado, Connecticut, Hawaii, Massachusetts, Maryland, Minnesota, New Hampshire, New Jersey, Nevada, Wisconsin, and Wyoming.

The share of seniors living in poverty under the supplemental measure is especially high in some areas. Based on the supplemental measure, about one in four seniors (26%) are living in poverty in DC and roughly one in five seniors are living in poverty in six states: California (20%); Hawaii, Louisiana, and Nevada (19%), and Georgia and New York (18%).

One possible reason that senior poverty rates in the aforementioned states are so high when taking medical expenses into account is that hospitals in those regions may charge more money for drugs and medical services — certainly a possibility considering that U.S. medical prices are essentially arbitrary. Another potential explanation is that these states have more seniors who are less likely to be eligible for Medicare due to immigration or citizenship status, and a higher number of poor seniors with chronic medical conditions.

But the key takeaway from the numbers is that, despite many seniors’ access to generous public health entitlements, they still can’t afford the associated costs of their medical care. And that means that efforts to reduce the federal deficit through cuts to health care programs amounts to putting more fiscal strain on a vulnerable population that can’t even afford treatments under the status quo.

Yet, the congressional GOP — and some Democrats — has vehemently encouraged such cuts. For instance, Republicans insisted on raising the Medicare eligibility age from 65 to 67 during budget negotiations in February, even though such a move would only net $5.7 billion in federal savings while shifting double that amount in costs onto seniors.

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Monday’s news that illegal abortion provider Kermit Gosnell has been convicted of first-degree murder has already inspired a flurry of reactions, including several calls to tighten restrictions on legal abortion clinics across the country. Throughout Gosnell’s high-profile murder trial, anti-choice activists have consistently pushed the message that abortion still lacks proper regulations — despite the hundreds of state-level restrictions that continue to be piled onto this aspect of reproductive health care — in an attempt to portray all abortion procedures as inherently dangerous and barbaric.

And now, abortion opponents are continuing to suggest that Gosnell is not an outlier, criticizing the pro-choice community for failing to implement the policies to prevent other unscrupulous providers from repeating his crimes. “Despite the blood-soaked horror of Gosnell’s clinic, Democrats refuse to loosen their embrace of unrestricted, unregulated, taxpayer-funded abortion on demand,” Rep. Steve Stockman (R-TX) said on Monday, suggesting that Gosnell’s case reveals that Democrats “worship” abortion.

But in reality, there’s no such thing as taxpayer-funded abortion on demand. Under the Hyde Amendment, federal dollars are not allowed to fund abortion services. In an ironic twist, the lack of federal funding for abortion services is actually a big contributing factor to the issues at the heart of the Gosnell case. And addressing the public funding ban under Hyde is the real policy solution that could prevent other bad actors like Gosnell from preying on vulnerable women.

Blocking public funds from covering abortion makes for a nice talking point for the anti-choice lawmakers who like to decry the immorality of “taxpayer-funded abortion.” But in practice, the Hyde Amendment means that the low-income women on Medicaid are forced to cover the entire cost of abortion out-of-pocket because their health care plan won’t help cover it. That contributes to a vicious cycle of poverty. Low-income women are more likely to lack access to affordable contraceptive and family planning services, and therefore have higher rates of unintended pregnancies and abortions. They’re more likely to struggle to pay for an abortion. And they’re more likely to slip further into poverty if they’re unable to obtain the abortion they wanted to have.

That’s how the Hyde Amendment, as well as the subsequent state-level bans on public funding that have been modeled on the federal law, ensures that reproductive rights are deeply divided by race and class. Despite the fact that Roe v. Wade has been in place for 40 years, each woman’s access to abortion care is largely dependent on her privilege — and the underprivileged women in the U.S. are paying the biggest price.

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In the ongoing war on women’s reproductive rights, the mounting pile of state-level abortion restrictions are pulling some parts of the country back to a time before Roe v. Wade, when a woman’s abortion access was largely dependent on her privilege. Even though Roe still stands, it doesn’t necessarily do much to protect the economically disadvantaged women who live in states that are hostile to abortion rights. That’s because anti-choice lawmakers are using several effective tactics to drive up the cost of abortion, essentially pricing poor women out of their reproductive rights.

Many Americans may not think of abortion rights as an economic justice issue. But the mounting economic barriers that stand between women and their reproductive care provide evidence that it is, in fact, an area that has an outsized impact on poorer Americans. Here’s how state lawmakers are working to make abortion too expensive for low-income women to access:

– Placing restrictions on the abortion pill. Non-invasive first-trimester abortions — in which women can safely terminate an early pregnancy by taking the RU-486 abortion pill — are the most common type of abortion care. The pill is an important reproductive resource particularly for low-income women who live in rural areas, and may not be able to travel to a clinic that offers surgical abortion procedures. Some states are attempting to improve those women’s access to abortion care even further by allowing them to use video technology to take the pill while supervised remotely by a doctor. But anti-choice lawmakers are waging a coordinated campaign against this practice, which they decry as “webcam abortion.” Just last week, Mississippi became the latest state to impose additional hurdles for women taking the pill, when Gov. Phil Bryant (R) signed a measure requiring the physician to by physically present to prescribe RU-486 and the women to make an in-person follow-up appointment.

– Driving up the cost of the abortion pill. When lawmakers place unnecessary restrictions on the abortion pill, they don’t just force disadvantaged women to figure out how to make a potentially expensive trip to a clinic. They also often drive up the cost of the pill itself. Several of the measures designed to make it harder for abortion clinics to prescribe RU-486 actually require clinics to adhere to an outdated FDA standard for the pill. The old standard requires a higher dosage, and that higher dosage necessitates a higher price. Medical experts, including the World Health Organization, agree that there is no real health benefit to increasing the medication’s dosage.

– Forcing abortion clinics out of business. Across the country, abortion opponents are advancing measures to force health clinics to close their doors. Just like tightening the requirements for the abortion pill, it’s easy for anti-choice lawmakers to make the case that strict standards for clinics are simply designed to keep women safe. But these laws aren’t about women’s safety at all. They represent an indirect method of attacking abortion access by going after the providers instead of banning the procedure itself, and they’re incredibly effective at forcing abortion clinics to shut down. And that means low-income women will incurr financial hardships — such as travel costs, the price of childcare, and missed wages at work — to travel farther distances to access the reduced number of clinics in their state. If some women are forced to delay their abortion services because they can’t travel to a clinic in time, they will end up paying even more money, since later abortion services become increasingly more expensive.

– Blocking insurance coverage for abortion services. Abortion opponents have successfully blocked public funding for abortion with the Hyde Amendment, which prevents the federal government from directly paying for abortion services. The majority of states across the country have adopted their own versions of this funding ban as well, so just 17 states will cover medically necessary abortions for poor women on Medicaid. It’s a popular talking point to make the case that the government shouldn’t pay for abortion — but in practice, that simply means that low-income women in the Medicaid program can’t get any insurance coverage for their reproductive care, and must pay for the entire procedure themselves. It’s not as much of a hardship for economically privileged women to pay out of pocket, but poorer women often can’t afford hundreds of dollars for an abortion. And now abortion opponents are attempting to use Obamacare to restrict abortion coverage for women who have private insurance plans as well.

There are class issues at play before and after abortion, too. Low-income women are less likely to have reliable access to contraceptives, and therefore have higher rates of unintended pregnancy and abortion. Understandably, considering all of the financial hardships that poorer women face as they attempt to obtain an abortion, not all of them are able to successfully terminate an unwanted pregnancy. But it’s a vicious economic cycle. If a woman cannot successfully obtain an abortion when she would have preferred to have one, she’s more likely to fall deeper into poverty.