Health
The Three States That Are Especially Stuck if Congress Cuts Medicaid
If congressional Republicans go through with some of the deep Medicaid cuts they are considering, three states would be left in an especially tight bind.
South Dakota, Missouri and Oklahoma have state constitutions requiring that they participate in Medicaid expansion, the part of Obamacare that expanded the health program for the poor to millions of adults.
If Republicans choose to make the projected budget reductions by cutting into Medicaid expansion, the other 37 states (and D.C.) that participate in the expansion could stop covering working-class adults. Nine states have laws explicitly requiring them to stop Medicaid expansion or make significant changes if the federal share of spending drops.
But South Dakota, Missouri and Oklahoma can’t do that. They either need to amend their constitutions, a lengthy process that can take years, or figure out how to fill the budget hole, most likely by cutting other services or raising taxes.
The constitutional amendments were put on state ballots by progressive activists, who wanted to entrench the Medicaid program in places that had been hostile to that part of the Affordable Care Act. The idea was twofold: to get health coverage to more people, and to tether more states and their Republican lawmakers to Medicaid.
The ballot initiatives passed by a wide margin, and now these states have more at stake in the congressional debate over Medicaid. Even some conservative senators, like Josh Hawley of Missouri, are speaking out against reducing funding for the program. The Republican senators from the three states with constitutional amendments could become an unlikely part of the firewall against big cuts to Medicaid.
“Expanding Medicaid anywhere protects it everywhere, which is now what we’re seeing today,” said Kelly Hall, executive director of the Fairness Project, the nonprofit that organized the constitutional amendment campaigns. She noted that her group expected the expansions would broaden support for the program in Washington.
The exact details of any cuts are still unclear, but Republicans in Congress hope to enact a detailed plan by the end of September. A budget resolution that passed the House last month called for at least $880 billion in cuts over a decade from the committee that oversees Medicaid. If all the cuts came from Medicaid, that amount would represent an 11 percent reduction in federal Medicaid spending, and millions would most likely lose coverage. The Senate passed its own budget Saturday that included the House numbers but was less clear on the scope of its preferred spending cuts.
Lawmakers and policy analysts who favor cuts argue that states no longer pay their fair share of Medicaid’s bills. In recent years, the federal share of spending on the program has grown to more than 70 percent overall from around 60 percent. The federal government pays 90 percent of the costs for working-age adults who enroll through the expansion, a high share that the architects of Obamacare meant to ease the burden of expansion from state budgets.
Because states would become responsible for what had once been paid by the federal government, the states with constitutional amendments would have especially high financial stakes. In Missouri, Medicaid funding makes up about 35 percent of the state’s entire budget. If the federal government pulled back, the state would probably have to raise taxes or cut other parts of its budget, like education or transportation.
The last time Republicans attempted major Medicaid changes, as part of their Obamacare repeal push in 2017, some Republican governors lobbied their senators to protect the program, and several voted against the bill. In the years since, seven more Republican-led states have expanded Medicaid by ballot measure, expanding coverage to 950,000 people.
Even after passing at the ballot, Medicaid expansion still faced opposition from elected officials charged with setting up the program. The former Maine governor Paul LePage went the furthest, claiming he would go to jail rather than carry out a Medicaid expansion. (The expansion was implemented after he was replaced by a Democrat.)
That resistance got the progressive activists who organized and funded the ballot initiative campaigns looking for a way to make Medicaid expansion more ironclad. For 2020, they came up with the idea of pursuing voter referendums to enshrine participation in the program in state constitutions. They succeeded in Missouri and Oklahoma in 2020, followed by South Dakota in 2022.
Those ballot initiatives took more work, requiring more signatures to get onto the ballot. Activists decided the extra hurdle was worth it to entrench Medicaid in areas of the country that had been hostile to the program — thus giving it more protection in Washington.
The politics of the Republican Party have changed since 2017, too, shifting from Tea Party austerity toward working class populism. Hospitals have also become more dependent on Medicaid as it has expanded, and more effective at arguing this point to government officials.
“The system is much more firmly in place now than it was eight years ago,” said Brendan Buck, who was an aide for Speaker Paul Ryan during the Obamacare repeal effort in 2017 and is now a partner in a communications firm that does work for health industry clients. “These are our states. These are our voters. And I think they will hear loud and clear if this does become a real threat.”
When he was Missouri’s attorney general, Mr. Hawley led two lawsuits seeking to overturn the Affordable Care Act. But in February and again this past week, he voted with Democrats on budget amendments to protect Medicaid. Those efforts were largely ceremonial. But Republicans may need his vote to advance their larger package of tax cuts and spending reductions later this year.
“Our voters voted for it — my constituents — by a decisive margin,” Mr. Hawley said of Medicaid expansion in a recent interview, noting that a fifth of the state gets health insurance through the program.
While Mr. Hawley said he would be comfortable voting to add a work requirement to the program, he was “not going to vote for cut benefits.”
Senator Mike Rounds of South Dakota has also opposed reducing federal funding for Medicaid expansion because of the financial burden it would put on states. “That’s not a cost-cutting measure — that’s a cost transfer,” he told Politico in February.
Even many blue states that passed expansion through their legislatures will probably stop Medicaid coverage for poor adults if cuts go through. Twelve states, including Illinois and Virginia, have passed legislation that would automatically rescind the expansion if federal funding dips.
The states with constitutional amendments are already beginning to prepare for the possibility of a major budget hole. In Oklahoma, for example, federal Medicaid funding makes up almost 30 percent of the state’s entire budget.
A conservative Oklahoma think tank has suggested that the state cut other parts of Medicaid to make up the gap instead of dipping into funding for services like roads or schools.
But reducing Medicaid services alone probably wouldn’t be enough to offset the lost federal funding. There are only a handful of ways states are allowed to cut the program, such as ending coverage for prescription drugs or no longer providing insurance to postpartum women.
In South Dakota, the Legislature passed a law in February that would alter the constitution to leave the program if federal funding dropped.
The new law wouldn’t immediately pull South Dakota out of Medicaid expansion but would give the Legislature the flexibility to do so. To change the constitution, voters would also need to weigh in with a new ballot initiative, scheduled for the state’s next election in 2026 — potentially after Congress passes cuts.
“I’m worried it won’t be soon enough, but that is when our next election is,” said Tony Venhuizen, who introduced the bill in January as a member of the State Legislature. “There isn’t another way.”
Catie Edmondson contributed reporting.
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A sperm donor whose samples helped conceive nearly 200 children across Europe unknowingly carried a cancer-causing genetic mutation — a hidden risk now tied to multiple childhood illnesses and early deaths.
An investigation led by the BBC and many other public service broadcasters revealed that the donations were made to Denmark’s European Sperm Bank (ESB). Those donations were then used by 67 fertility clinics in 14 countries over a 17-year span.
The donor, who was not identified, was paid to donate as a student beginning in 2005, according to the report.
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Although the donor passed the initial health screenings, he had hidden genetic mutations that damaged the TP53 gene, which helps to prevent cancer by repairing DNA damage or trigger the death of cancer cells.
When TP53 is mutated, those protective functions are lost, which can lead to uncontrolled cell division, accumulation of mutations and tumor growth, research has shown.
A sperm donor whose samples helped conceive nearly 200 children across Europe (not pictured) unknowingly carried a cancer-causing genetic mutation — a hidden risk now tied to multiple childhood illnesses and early deaths. (Getty Images)
Up to 20% of the man’s sperm would contain that mutated gene, and any children conceived from that affected sperm would have the mutation in every cell of their body, the BBC report stated.
As a result, these children would have a 90% risk of developing some type of cancer in their lifetime, including breast cancer, bone cancers, brain tumors and leukemia. This heightened risk is known as Li Fraumeni syndrome.
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Doctors raised these concerns at the annual congress of the European Society of Human Genetics (ESHG), which was held in Milan in May 2025.
At that conference, Edwige Kasper — a specialist in cancer genetics at Rouen University Hospital in France — presented the case of the sperm donor whose genetic material carried the harmful variant.
“This is the abnormal dissemination of genetic disease. Not every man has 75 children across Europe.”
It was reported that 23 children had been confirmed to have the variant at that time, 10 of which had already been diagnosed with cancer.
The actual number is likely much higher, the report surmised, as at least 197 children were born from the donated sperm — but not all data has been collected.
Kasper called for a limit on the number of births or families for a single donor in Europe.
“We can’t do whole-genome sequencing for all sperm donors — I’m not arguing for that,” she said. “But this is the abnormal dissemination of genetic disease. Not every man has 75 children across Europe.”
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She also recommended that children born from this donor’s sperm undergo genetic counseling.
“We have some children that have already developed two different cancers, and some of them have already died at a very early age,” Kasper recently told the investigators.
Up to 20% of the man’s sperm would contain that mutated gene, and any children conceived from that affected sperm would have the mutation in every cell of their body, the BBC report stated. (iStock)
There is no worldwide law that limits how many times a donor’s sperm can be used or how many children may be born from a single donor, according to the European Society of Human Reproduction and Embryology (ESHRE).
However, individual countries may have their own rules or guidelines surrounding sperm donor usage. The ESHRE recently proposed a cap of 50 families per donor as an international limit.
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Dr. Marc Siegel, Fox News senior medical analyst, commented on these developments to Fox News Digital.
“This awful story emphasizes the growing need for up-to-date genetic screening for all donors,” he said. “It also provides context for the idea that knowing the donor provides an advantage.”
“This awful story emphasizes the growing need for up-to-date genetic screening for all donors,” Dr. Marc Siegel said. (iStock)
“Genetic screening, including for oncogenes (genes that have the potential to cause cancer) is improving dramatically, and all use of sperm donations must include it,” Siegel went on.
He also called for AI to be used to improve and speed up the process.
“When a propensity for disease is suspected, the sperm must be discarded,” the doctor added.
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In a statement sent to Fox News Digital, the European Sperm Bank expressed “deepest sympathy” for the families involved.
“We are deeply affected by the case and the impact that the rare TP53 mutation has on a number of families, children and the donor. They have our deepest sympathy,” the ESP said.
The American Society of Reproductive Medicine provided its guidance on embryo and gamete donation, which stated in part that all prospective donors should undergo “appropriate genetic evaluation.” (iStock)
“ESB tests and performs an individual medical assessment of all donors in full compliance with recognized and scientific practice and legislation.”
In the case of this particular sperm donor with the TP53 mutation, the ESB noted that it occurs only in a small part of the donor’s sperm cells and not in the rest of the body.
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“In such cases, the donor himself and his family members are not ill, and a mutation of this type is not detected preventively by genetic screening,” the agency said.
When the ESB later confirmed the mutation in 2023, the donor was “immediately blocked” and authorities and clinics were notified.
“Donors should be healthy and have no history to suggest hereditary disease.”
“The clinics are responsible for informing the patients, partly because we as a sperm bank do not necessarily know the patients, and because the patients’ own treating physicians are best equipped to advise them in the specific situation,” the agency stated.
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When contacted by Fox News Digital, the American Society of Reproductive Medicine (ASRM) provided its guidance on embryo and gamete donation, which stated in part that all prospective donors should undergo “appropriate genetic evaluation.”
“Donors should be healthy and have no history to suggest hereditary disease,” the ASRM continued.
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Parents with concerns are encouraged to contact both their treating clinic and the relevant fertility authority in that country.
GLP-1 weight loss pill in development
Fox News senior medical analyst Dr. Marc Siegel discusses advancements in weight loss drugs, safety concerns surrounding nicotine patches and his interview with FDA Commissioner Dr. Marty Makary on vaccine protocol.
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Scientists in Sweden have created a new pill designed to help the body burn fat and control blood sugar in a different way than popular GLP-1 drugs, like Ozempic.
While injectable GLP-1s work by suppressing appetite, this new treatment boosts metabolism in the muscles.
A study led by researchers at Karolinska Institutet and Stockholm University included both an early animal study and a human clinical trial with 48 healthy adults and 25 people with type 2 diabetes, according to a press release.
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The new oral medication was found to successfully control blood glucose, boost fat burning and retain muscle mass in animals, while getting high marks for tolerability and safety in humans.
It was also found to have fewer side effects than GLP-1s like semaglutides and tirzepatides, which are known to cause appetite loss, gastrointestinal distress and muscle wasting, the researchers noted.
While injectable GLP-1s work by suppressing appetite, this new treatment boosts metabolism in the muscles. (iStock)
The experimental medication uses a new form of beta-2 agonist that benefits muscle function while also avoiding overstimulation of the heart, which has been identified as a potential safety concern of older versions.
The findings were published this week in the journal Cell.
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Because the new oral drug acts via a different mechanism than appetite-suppressing medications, it could be used alone or in combination with GLP-1s, the researchers noted.
“Our results point to a future where we can improve metabolic health without losing muscle mass,” said Tore Bengtsson, professor at the Department of Molecular Bioscience at Wenner-Gren Institute, Stockholm University, in the release. “Muscles are important in both type 2 diabetes and obesity, and muscle mass is also directly correlated with life expectancy.”
“Muscles are important in both type 2 diabetes and obesity, and muscle mass is also directly correlated with life expectancy.” (iStock)
This medication has the potential to be of “great importance” for patients with type 2 diabetes and obesity, according to Shane C. Wright, assistant professor at the Department of Physiology and Pharmacology at Karolinska Institutet.
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“Our substance appears to promote healthy weight loss and, in addition, patients do not have to take injections,” he added.
Dr. Trey Wickham, interim chief of the Division of Endocrinology, Diabetes & Metabolism at VCU Health in Richmond, Virginia, was not involved in the study but shared his reaction to the publication in the journal Cell.
“Our results point to a future where we can improve metabolic health without losing muscle mass.”
“This compound’s mechanism of action could address some specific metabolic concerns with previous weight reduction therapies, such as the loss of both muscle and fat tissue,” Wickham told Fox News Digital.
“Although the reported preliminary results are interesting, rigorous testing involving larger longitudinal trials are necessary to ensure human long-term safety and understand the potential role of this compound in the comprehensive, evidence-based treatment of obesity and diabetes.”
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The study had some limitations, the researchers noted, chiefly that the preclinical studies in mice fail to capture the “complex nature of these diseases” in humans.
Structural studies are needed to understand exactly how the drug works.
“This compound’s mechanism of action could address some specific metabolic concerns with previous weight reduction therapies, such as the loss of both muscle and fat tissue,” a doctor said. (iStock)
“Our phase 1 data show that compound 15 is well-tolerated; however, conclusive clinical efficacy data (on how the drug controls glucose metabolism) are currently still lacking.”
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Looking ahead, the company that developed the drug, Atrogi AB, plans to conduct a larger phase 2 clinical trial with a larger, more diverse population, including people with obesity.
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The study was supported in part by the Swedish Research Council, the Swedish Society for Medical Research and the Novo Nordisk Foundation.
Uppsala University, University of Copenhagen, Monash University and University of Queensland all collaborated with the lead researchers.
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The world’s first GLP-1 weight loss treatment is being administered for pets on an experimental basis.
The first cat was successfully dosed in the MEOW-1 study of OKV-119 – an investigational “ultra-long acting” GLP-1 implant, which, according to a press release, is being developed for weight management in cats.
OKAVA Pharmaceuticals, the San Francisco-based manufacturer of the medication, said the landmark clinical study of the “first-in-class” device could have “profound” implications for diabetes, kidney disease, healthy aging and longevity in pets.
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The implant allows for continuous delivery of a GLP-1 receptor agonist, improving cardio-metabolic health and potentially “enhancing quality of life” while extending it, according to the release.
Once it is available, the single implant may be administered during a routine visit to a cat’s veterinarian, with guaranteed delivery of the medication for up to six months.
The OKV-119 implant guarantees administration of the drug for six months. (iStock)
The MEOW-1 trial marks the first of its kind for clinical investigation of weight loss in cats and dogs, following the breakthrough of GLP-1 use in humans for the management of obesity and diabetes.
OKAVA CEO Michael Klotsman, Ph.D., wrote in a statement that caloric restriction, or fasting, is “one of the most well-established interventions for extending lifespan and improving metabolic health in cats.”
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“But it’s also one of the hardest to maintain,” he said. “OKV-119 is designed to mimic many of the physiological effects of fasting — improved insulin sensitivity, reduced fat mass and more efficient energy metabolism — without requiring significant changes in feeding routines or disruption of the human-animal bond that often centers around food.”
Future research will consider weight management in dogs, the researchers said. (iStock)
The MEOW-1 study aims to evaluate the safety, tolerability and efficacy of the weight-loss medication in overweight or obese cats. The results will guide future clinical development, as well as a similar study in dogs, according to the researchers.
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Dr. W. Chris Hummel, a veterinarian at Lovet Pet Health Care in Phoenix, Arizona, who was not involved in the study, confirmed that several GLP-1 drugs are under investigation in domestic animals.
A GLP-1 treatment for cats does not require changes in feeding that may disrupt human-animal bonding, the researchers stated. (iStock)
“Preliminary evidence suggests that GLP-1 and GLP-like drugs can be effective alternative therapies for diabetes mellitus, otherwise known as sugar diabetes,” he told Fox News Digital. “Diabetes mellitus is one of the fastest-growing diseases in cats and dogs, largely on the heels of the pet obesity epidemic.”
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“The medications are given by injection, so long-acting combinations are currently being investigated for efficacy and duration,” Hummel added. “The data is still early, but promising.”
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