Why are so many women who want sterilizations not getting them? NPR memorializes 30 years of AIDS with a series of programs about the modern state of the disease. Red states are now moving to reject the ACA.

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Melinda Gates supports contraception

NPR’s series on HIV & AIDS

Bobby Jindal’s weird defense of himself

Rick Perry hopes his smirks distract you from his bad arguments

Limbaugh denounces women’s suffrage

On this episode of Reality Cast, J. Bryan Lowder will be on to discuss women who want to be sterilized but meet resistance from doctors. NPR takes a long look at the AIDS crisis thirty years in to it, and red state governors are toying with the idea of rejecting the Affordable Care Act.

Last week saw the London Summit on Family Planning, and as part of the kick-off, Melinda Gates and the Gates Foundation made a strongly worded video in support of contraception rights and access around the world.

• gates *

The research showing that contraception could reduce the maternal mortality rate in developing countries by one-third is getting a lot of play, which is great. The statistic about children shows exactly who in this fight actually cares about the lives of children.

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Three decades into the AIDS epidemic, NPR decided to do a series of stories about the current state of HIV/AIDS: the research, the outreach, the policy, and the people who live with it. And those who died of it, which is something that surprisingly doesn’t get talked about as much as it used to. Part of that is because people with HIV now have access to drugs that can keep them alive, often for decades, without ever actually having the virus develop into AIDS. I think, sometimes, that leads us to forget that AIDS is an extremely fatal disease and, if it’s not treated, is nearly completely fatal but for a few rare cases, and fatal in a rapid period of time between infection and death. But that topic was directly addressed in a piece about the AIDS quilt, where they interviewed people memorializing their lost loved ones.

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Of course, the death rate from AIDS just isn’t what it used to be, though how long you have to live after being diagnosed with HIV depends on a lot of factors: health insurance, class status, race, sexual identity, profession, other health factors. You could go on for days about it. But absolutely, it’s not a death sentence like it used to be, and the reason for that is drugs, full stop. HIV drugs keep the virus from taking over your system, and have a side effect of making you less contagious, though if you’re HIV positive you should always use condoms and not take a chance. NPR did a couple of reports on how these drugs have pretty much been a miracle in places where AIDS fatalities literally threatened to destroy their communities and even their nations. Botswana, for instance, was looking at HIV rates of 25% of adults, and took serious measures.

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Now the culture of daily AIDS funerals has really turned around, mostly due to internal government intervention with the help of some outside funding sources. Not every nation has as many resources as Botswana, however, and so getting that level of help out to their citizens requires wealthier nations to step in and help out. To everyone’s great surprise, it was President Bush of all people who spearheaded such a program, called PEPFAR. Now, I’ve been critical of PEPFAR on this program, especially regarding concerns that they weren’t invested enough in preventing transmission of HIV. But the whole thing has been pretty successful in keeping people from dying of AIDS around the world, as NPR reports by focusing on how it’s working in Haiti.

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NPR also looked closer to home, because while HIV has faded from the public imagination as a real problem here, there is still an AIDS crisis that isn’t getting the coverage it deserves. More than a million Americans have HIV, which amounts to 1 in 300, which falls well below where it’s at in some more AIDS-ravaged countries, but is something to be extremely concerned about. Unfortunately, one reason perhaps the HIV epidemic doesn’t get the attention it deserves is that black people are disproportionately infected. By like a whole lot.

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Robert Fullilove, a professor of sociomedical studies at Columbia, talked some more on Terri Gross’s show about the extent of the problem.

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Thirty years into the epidemic, we have reasons to hope, but also so much work to do. Only half the people worldwide who need HIV drugs are getting them, and even in our wealthy nation, certain populations are seeing their HIV transmission rates rising. With all the wealth and education we have, this shouldn’t be happening.

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insert interview

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For those of us who thought the fight over the Affordable Care Act was all over but the whining after the recent Supreme Court decision upholding pretty much every item in the act, well, we should have known better. The right doesn’t go gently into that good night, and frankly, this is one of the ugliest and most avid bouts of right wing resistance to new legislation since the battle over the Civil Rights Act of 1964 and the Voting Rights Act of 1965. It’s not just the end of the world rhetoric that’s on talk radio and no doubt clogging up your Facebook feed from your right wing friends. The right is organizing forces to undermine and chip away at this legislation in every way they can. And the first strategy out the door is red state governors declaring that they won’t play along. Governor Bobby Jindal of Louisiana was the first out of the gate, testing the waters. He said that Louisiana will not accept the Medicaid extension and will not be setting up a state exchange for health insurance. This, weirdly, was his justification:

• health care 1 *

Wow, that was a bunch of nonsense in what sounded like one breath. First of all, premiums went up, yes, but that’s before the reforms were actually implemented, and so could have nothing to do with the ACA. The claim that Medicare won’t be protected is just strange, and his source is no one I’ve ever heard before. The Congressional Budget Office director has actually said that even though it’s only starting to be implemented, the ACA is slowing down Medicare spending. The claim that 20 million Americans will lose health insurance is unsourced, but I suspect he’s talking about the Americans expected to drop their employer insurance and instead buy from the exchanges because they get a better deal. I hardly see how that’s a problem. And he never addresses, not for a second, why any of this should mean that his state will reject allowing people that make up to 133% of the poverty line to get on Medicaid. If he’s concerned about actually getting health care to people, that’s a way to do it that doesn’t involve premiums, employers, or any of the other concerns he mentions at all.

Even though Gov. Jindal’s excuse for refusing to cooperate with the feds on this one made not one bit of sense, it doesn’t mean that he doesn’t have another, equally right wing governor following right behind.

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As you can imagine, Rick Perry was equally inept at explaining why while pretending he’s even remotely interested in getting the 25% of Texans that don’t have health insurance into a health care plan.

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You can drop the word “socializing” as much as you want, but that doesn’t change the fact that this bill has nothing to do with “socializing” anything, though I wish that it did. Canada and England have so-called socialized health care, and people there pay ridiculously low premiums into a single payer system that is much easier to navigate than most insurance companies. This bill simply makes it easier and more affordable to buy private insurance, and gets rid of some of the red tape, but there isn’t a government-owned insurance company you pay into. There just isn’t, no matter how much conservatives imply otherwise. Additionally, the claim that exchanges reduce freedom is the opposite of true. The point of the exchanges is to put all the insurers in one bucket so they have to compete on a—wait for it—free market that allows consumers to make the best choice for themselves. If you really believe in a free marketplace that maximizes consumer choice, you should love this.

Repeat: One in four Texans is uninsured. Perry may want to pretend this is about coming up with a “better” system, but he’s not offering one. The current performance of Texas suggests instead that he just doesn’t care. It’s also worth noting that by rejecting the responsibility to put together state exchanges, Texas and Louisiana are both letting the federal government swoop in and create exchanges for them. They claim they’re all about local government and taking power out of federal hands, but by doing this, they’re actually moving more government to the federal level.

I fully expect more governors to follow suit, though in the long run, there’s reason to believe the rejection of the Medicaid expansion, which will leave 1.8 million Texans uninsured alone, won’t last forever. Few states refuse free money for very long.

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And now for the Wisdom of Wingnuts, Rush Limbaugh says what he really means edition. You probably heard this, but if you didn’t:

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I love that he tries to pass it off as a joke, but you can tell from the tone of his voice that he wasn’t joking. He got caught up in a game of right wing one-up-manship with a caller who wants to raise the voting age to 21 and got caught out saying something he sounds like he says in private all the time.