Wisconsin Gov. Scott Walker (R) has decided to reject Obamacare’s optional Medicaid expansion, opting instead for an alternative — and risky — plan for providing low-income Americans with private health coverage that will prevent many of them from accessing the types of services that they can get under Medicaid.

As Politico reports, Walker’s plan “would take thousands of people currently on Wisconsin’s relatively generous Medicaid program — people who are above the federal poverty level — and move them into the Obamacare exchange instead, where they can get federally subsidized private insurance.” The plan would actually cut Wisconsin’s Medicaid program in the aggregate, shifting low-income Wisconsinites above the federal poverty level away from the public insurance program and into the state’s Obamacare-funded private insurance marketplace. It is also estimated to cut the state’s uninsurance rate in half, and Walker claims that the move is intended to “preserve an essential safety net for our neediest, while protecting our state’s taxpayers from uncertainty” over whether or not the federal government will follow through on its promise to fund the lion’s share of states’ Medicaid expansions.

While it’s an interesting proposal from a GOP governor who is not known for compromising with political opponents, it’s still a raw deal for low-income Americans, as it will restrict the number of specialty medical services that poor Wisconsinites have access to. That’s because Medicaid provides a range of benefits that lower-tier private health plans — which are the only kind that poor Americans will be able to afford under Walker’s plan — don’t cover. As Harold Pollack wrote for The Incidental Economist, “There is no genuine private-sector equivalent for many Medicaid services provided to disabled individuals with special needs.” Those services include specialized benefits such as home care and social worker visits to assist impoverished first-time moms — benefits that might not be necessary for well-positioned Americans who may opt for a lower-cost health plan, but make an enormous difference to low-income populations with unique needs.

Physical disabilities, mental health issues, and a whole host of other socially and financially costly medical conditions disproportionately plague low-income Americans. To illustrate exactly how Walker’s alternative to expanding Medicaid will tangibly affect Wisconsin residents, consider a low-income pregnant woman who suffers from depression. Medicaid currently covers mental health services for “medically needy” pregnant women up until six months after they give birth — but states that expand Medicaid under Obamacare will be able to provide moms these mental services for long after that cutoff. Granted, private plans sold on Obamacare marketplaces must meet federal benchmarks and provide an array of “essential health benefits,” including mental services. But the rules governing the scope and quality of these services are much less stringent for private plans than they are for Medicaid. That’s pretty significant considering the fact that 82 percent of infants living in households with depressed mothers were enrolled in Medicaid or CHIP programs.

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When anti-choice lawmakers in Wisconsin imposed unnecessary restrictions on medication-induced abortions, they claimed they wanted to make sure the procedure was safe. But now that women in the state can’t access the abortion pill to terminate a pregnancy within the first trimester, they’re being forced to delay the procedure until they can receive a more invasive surgical abortion — which can actually slightly increase the health risks for some patients, in addition to putting women through the strain of being denied the right to terminate a pregnancy when and where they would prefer to do so.

Of course, surgical abortions are still an extremely safe medical procedure. But in Wisconsin, they require a more involved process than medicine-induced abortions, forcing women to make several trips to a doctor’s office and denying her the opportunity to choose where she would prefer to terminate her pregnancy.

That’s exactly what happened to Samantha, a Milwaukee-based woman withholding her last name to protect her privacy. As the Wisconsin Center for Investigative Journalism reports, the state’s new law prevented Samantha from accessing the RU-486 abortion pill in the privacy of her own home — and ultimately made the experience a more emotionally stressful one than it would have been otherwise:

Samantha later learned that state lawmakers were planning to change the rules for medication abortions, which could make it more difficult to obtain follow-up care.

“That was really scary,” said Samantha, who decided to wait several weeks to have a surgical abortion as she juggled work and school. She was fatigued and depressed. [...]

Samantha said that in addition to a medication abortion being available earlier, the procedure would have afforded more privacy. During her surgical abortion, she said, there were “six other people in the room,” including medical students.

“It was really overwhelming and obviously painful, too,” she said. “I really wish I could have had the privacy of being in my own room and dealing with just the people affected, just me and my partner.”

Nicole Safar, the public policy director for Planned Parenthood Advocates of Wisconsin, explains that many women do prefer earlier, medication-induced abortions for the privacy they offer. “More than the physical piece, for many women medication abortion is the right choice for her entire self — emotionally, psychologically,” Safar told the Wisconsin Center for Investigative Journalism. “Many women would prefer to go through the process at home, with their family. That’s a huge piece of it you can’t really quantify.”

But since the state law took effect in April, Planned Parenthood clinics across the state haven’t been able to offer medication abortions to their patients — which means that countless women like Samantha are being forced to either have a surgical abortion or travel across state lines to obtain the abortion pill. The women’s health organization is suing the state to overturn the law and restore women’s access to medicine-induced first-trimester abortions.

Making the RU-486 pill widely available has been proven to effectively lower the rate of later-term abortions, since it allows women to make their reproductive decisions as soon as possible. Nevertheless, anti-choice lawmakers insist on imposing unnecessary restrictions on medication abortion and the medical professionals who administer it, even at the expense of women’s privacy and emotional well-being.

Just like Texas lawmakers’ decision to restrict access to contraceptive services will lead to higher rates of unintended pregnancy in the state, Wisconsin’s new restrictions on first-trimester abortion services are already forcing women to put off the medical procedure, leading to an uptick in later term abortions.

Even though Wisconsin already requires written consent before doctors may perform an abortion, anti-choice lawmakers pushed through a new measure that imposes additional hurdles for women who seek medicine-induced abortions during their first nine weeks of pregnancy. Planned Parenthood’s Wisconsin affiliate is suing to restore women’s full access to reproductive services, arguing that the restrictive state law is ultimately resulting in increased later term abortions because it makes it more difficult for doctors to administer the abortion pill:

The suit alleges the law does not clearly spell out what a physician must do to satisfy all of the requirements of the law. [...] Planned Parenthood, which performed roughly two-thirds of the 7,019 abortions in Wisconsin last year, stopped offering medication abortions in April when the law took effect. Officials said they could not provide the best care for their patients while protecting their doctors from criminal liability. The nonprofit continues to offer surgical abortions at its clinics in Madison, Milwaukee and Appleton.

In an interview Tuesday, Dr. Douglas Laube of Madison said the reduction in pill abortions has forced some women to terminate their pregnancies later since surgical abortions can’t be performed in the first weeks of pregnancy. Surgery also can be more dangerous for patients with certain physical conditions, he said.

“It is legislated medicine rather than evidence-based practices,” said Laube, past president of the American College of Obstetricians and Gynecologists.

Under Wisconsin’s law, women must visit the same doctor three separate times before they can take the RU-486 abortion pill — including once for a “counseling session” so their doctor can determine they’re not being “coerced” into the procedure. And since the doctors who don’t follow the new requirements can be subject to criminal charges, other women’s health clinics in the state have also followed Planned Parenthood’s lead and stopped offering medical abortions because they believe it is too legally risky.

Despite the fact that medicine-induced abortions during the first trimester of pregnancy are noninvasive, safe, and effective, right-wing lawmakers often push to restrict women’s access to the abortion pill. In rural areas where women may not have access to nearby abortion doctors, telemedical abortions — allowing doctors to prescribe and administer the RU-486 pill over a video conference — can help decrease the number of second trimester abortions by allowing women to access abortion services sooner, but anti-choice lawmakers have still insisted on working to outlaw the practice.