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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GLP-1 has become a popular buzzword in the weight-loss community — but now some are touting “GLP-3s,” claiming they are taking obesity medications to the next level.
GLP-1 (glucagon-like peptide-1) medications work by mimicking a naturally occurring hormone in the body that helps regulate blood sugar and appetite.
The informal term “GLP-3” refers to a new triple-agonist drug that targets three hormones: GLP-1, GIP (glucose-dependent insulinotropic polypeptide, another naturally occurring hormone released by the gut after eating) and glucagon receptors. The most advanced example is retatrutide by Eli Lilly, according to clinical trial outcomes.
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The New England Journal of Medicine published results from a 2023 phase 2 retatrutide trial for obesity, revealing “substantial reductions in body weight” after 48 weeks of treatment.
A 12 mg once-weekly injection led to a 24.2% weight reduction, and participants continued to drop pounds after the 48-week trial period.
GLP-1 (glucagon-like peptide-1) medications work by mimicking a naturally occurring hormone in the body that helps regulate blood sugar and appetite. (iStock)
Side effects were reportedly similar to GLP-1 medications, most commonly including gastrointestinal complications like nausea, vomiting and diarrhea. Heart rate increases were noted, depending on the dose.
How it’s different
Retatrutide mimics three natural hormones found in the body, compared to GLP-1s that simulate just one hormone, according to a report by GoodRx pharmacists.
GIP and GLP-1 hormones signal the pancreas to release insulin after eating, while slowing digestion to help initiate feelings of fullness.
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These hormones target the area of the brain that regulates appetite and influences food cravings, the report noted.
The third hormone, glucagon, speeds up metabolism and helps the body break down fat cells for energy. That hormone also tells the liver to make new sugar, which is kept in check by GIP and GLP-1 activity, preventing blood sugar spikes.
Participants in the phase 3 trial saw an average weight loss of 71.8 pounds. (iStock)
“This added metabolism boost can add to and complement GIP’s and GLP-1’s actions. And that’s why it seems to provide significant weight loss,” the GoodRx website states. “If approved, retatrutide will be the first in a new class of medications.”
Eli Lilly announced results from its phase 3 trial TRIUMPH-4 in December, testing retatrutide’s effect on weight loss and other health conditions.
“We believe retatrutide could become an important option for patients with significant weight loss needs and certain complications.”
Participants with obesity and knee arthritis who took a 12-mg dose of retatrutide saw an average weight loss of 71.8 lbs (28.7%) at 68 weeks.
“For retatrutide, the findings from TRIUMPH-4 are encouraging, and with seven additional phase 3 readouts expected in 2026, we believe retatrutide could become an important option for patients with significant weight loss needs and certain complications, including knee osteoarthritis,” a Lilly spokesperson said in a statement to Fox News Digital.
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The drug also reduced Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores by an average of 75.8%, marking “significant improvements” in comfort level and physical function.
More than one in eight patients reported being “completely free” from knee pain at the end of the trial, according to a press release from Lilly.
Participants with obesity and knee arthritis who took a 12-mg dose of retatrutide saw an average weight loss of 71.8 lbs (28.7%) at 68 weeks. (iStock)
Seven additional phase 3 trials for retatrutide are expected to wrap up in 2026. The drug could see FDA approval in 2027, according to GoodRx.
The Lilly spokesperson noted that there have been no studies comparing retatrutide to GLP-1 treatments due to “differences in study design and patient populations.”
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Despite limited data availability on the drug, the medication could also be applied to treat other conditions like type 2 diabetes, kidney disease, cardiovascular risk reduction and metabolic dysfunction, according to GoodRx and other experts.
Fox News senior medical analyst Dr. Marc Siegel noted that Lilly’s Zepbound and Mounjaro already target two metabolic pathways — GLP-1 and GIP — which work together to promote weight loss, reduce hunger and inflammation, improve insulin function and slow digestion.
The doctor confirmed that the new drug, with its third receptor agonist, will further decrease hunger while increasing the feeling of fullness.
More than one in eight patients reported being “completely free” from knee pain at the end of the trial. (iStock)
“The weight loss in clinical trials is even more substantial, and the most likely reason that it decreases orthopedic problems is because of the weight loss — less stress on the joints and the decreased inflammation,” Siegel added.
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The most common side effect of GLP-3s is gastrointestinal symptoms, the doctor confirmed. Rarer side effects may include pancreatitis, gallstones and heart arrhythmia.
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Philip Rabito, M.D., a specialist in endocrinology, weight loss and wellness in New York City, shared in an interview with Fox News Digital that this new class of weight-loss drugs is positioned to “approach bariatric surgery level outcomes” — although it doesn’t come without risks.
“The novel glucagon‑agonist component introduces less‑understood long‑term safety considerations, so it is imperative that patients are followed closely by healthcare professionals experienced with this class of medicines, with cautious, stepwise use, despite the impressive efficacy,” he cautioned.
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The release of an updated food pyramid this week has sparked mixed reactions from doctors and dietitians.
One of the most noteworthy shifts in the 2025-2030 Dietary Guidelines for Americans — announced by HHS officials during a Jan. 7 press conference at the White House — is a greater emphasis on “high-quality proteins,” including red meat and eggs, as well as full-fat dairy.
The new guidelines focus on “real, whole, nutrient-dense foods,” and a dramatic reduction in highly processed foods, added sugars, refined carbohydrates and unhealthy fats.
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“Protein and healthy fats are essential and were wrongly discouraged in prior dietary guidelines,” Health Secretary Robert F. Kennedy Jr. said during the press conference. “We are ending the war on saturated fats.”
Nick Norwitz, a Harvard- and Oxford-trained researcher known for his work in metabolic health, shared his reaction to the new guidelines.
The release of an updated food pyramid this week has sparked mixed reactions from doctors and dietitians. (realfood.gov)
Despite how the new pyramid is presented, he noted, the actual guidelines for saturated fat consumption haven’t changed, as they still state that, “in general, saturated fat consumption should not exceed 10% of total daily calories.”
The intake of unprocessed whole foods rich in saturated fat, especially dairy fat, tends to be associated with improved health outcomes, according to Norwitz.
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“Full-fat dairy — especially cheese, for example — tends to be associated with lower BMI, reduced rates of diabetes and even reduced dementia risk,” he told Fox News Digital. “There are, of course, nuances — but ‘ending the war’ on saturated fat seems reasonable.”
Risks vary, experts say
Experts cautioned about the potential health risks of exceeding the recommended intake of saturated fat, including higher rates of LDL “bad” cholesterol, which is known to increase the risk of cardiovascular disease.
“The recommendation to limit saturated fat to 10% of total calories is based on the research showing that higher rates increase LDL cholesterol and associated risks for cardiovascular disease,” Sherry Coleman Collins, a food allergy dietitian and expert from the Atlanta metropolitan area, told Fox News Digital.
One of the most noteworthy shifts in the 2025-2030 Dietary Guidelines for Americans is a greater emphasis on “high-quality proteins” — including red meat and eggs — as well as full-fat dairy. (iStock)
Nutrition should be personalized and is dependent on multiple factors, she said, including age, gender, activity level and genetic risk factors.
“The total saturated fat an individual might safely consume is influenced by their size and total calorie needs, as well as potentially genetic differences,” Coleman Collins said.
Norwitz agreed, adding that “the specific food source and interaction with the unique host and their broader dietary context should take the spotlight.”
Dr. Pooja Gidwani, a double board-certified doctor of internal medicine and obesity medicine in Los Angeles, pointed out that not everyone has the same “tolerance” for saturated fats.
“If increasing saturated fat leads to a meaningful rise in LDL cholesterol or ApoB (Apolipoprotein B, a protein found on the surface of certain cholesterol-carrying particles in the blood), that intake level is excessive for that individual, regardless of improvements in weight or glucose metrics,” she said.
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“This personalized approach becomes increasingly important in midlife and beyond, when cardiovascular disease becomes the dominant driver of morbidity and mortality and when tolerance for cumulative atherogenic (artery-clogging) exposure is lower.”
For those who need to reduce LDL cholesterol or have a higher cardiovascular risk, the American Heart Association recommends an even lower amount of saturated fats — less than 6% of total daily calories.
Experts cautioned about the potential health risks of exceeding the recommended intake of saturated fat, including higher rates of LDL “bad” cholesterol. (iStock)
Gidwani also cautioned that diets emphasizing saturated fat could crowd out fiber and unsaturated fats, “both of which play independent roles in cholesterol clearance, insulin sensitivity, gut health and inflammation.”
“Saturated fat-heavy patterns are also calorie-dense, which can quietly undermine long-term weight management if intake is not carefully regulated,” she added.
Not all saturated fats are equal, experts say
The effects of saturated fat depend on what specific foods are being consumed, according to experts.
“I would recommend choosing minimally processed or unprocessed forms of foods,” said Tanya Freirich, a registered dietitian nutritionist in Charlotte, North Carolina. “For example, in place of a hot dog — which has additives, nitrites, sodium and fillers — consuming a chicken thigh would be a much better choice.”
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Gidwani reiterated that the amount of processing plays a big role.
“Processed meats are consistently associated with worse cardiometabolic outcomes and represent the clearest category to limit,” she said. “The risk here is not only saturated fat, but also sodium load, preservatives and the broader dietary pattern they tend to accompany.”
“Full-fat dairy — especially cheese, for example — tends to be associated with lower BMI, reduced rates of diabetes and even reduced dementia risk,” an expert told Fox News Digital. (iStock)
Unprocessed red meat, the doctor said, can fit into an overall healthy diet in smaller amounts, particularly when consumed alongside fiber-rich plants and minimally processed foods.
“However, from a longevity perspective, it should be viewed as optional rather than foundational, especially for individuals with elevated cardiovascular risk,” she added.
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When it comes to dairy, Gidwani noted that fermented options are “metabolically more favorable” than butter or cream.
“However, saturated fat from dairy is still not necessary to prioritize for metabolic health or longevity,” she said. “Excessive reliance on dairy fat can displace healthier fat sources without offering clear long-term benefit.”
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Overall, the doctor recommends unsaturated fat sources, including extra virgin olive oil, nuts, seeds, avocado and omega-3-rich fish, as primary dietary fats.
“These consistently support lipid profiles, insulin sensitivity and vascular health,” Gidwani said. “Saturated fat can exist within a balanced diet, but it should remain secondary rather than emphasized.”
Why the big picture matters
Saturated fat is just one piece of a much wider nutrition puzzle, the experts agreed.
Unprocessed red meat can fit into an overall healthy diet in smaller amounts, particularly when consumed alongside fiber-rich plants and minimally processed foods, one expert said. (iStock)
“Our heart health is not determined by one type of fat or one type of cholesterol, but the sum of many parts — our entire diet, our exercise habits, our stress and so much more,” Freirich said.
She recommends consulting a registered dietitian for guidance on unique dietary needs based on age, gender, activity level and medical history.
“Our heart health is not determined by one type of fat or one type of cholesterol, but the sum of many parts — our entire diet, our exercise habits, our stress and so much more,” said an expert. (iStock)
New Jersey-based dietitian Erin Palinski-Wade, author of “2-Day Diabetes Diet,” added that the message should be to focus more on overall patterns.
That means “plenty of fiber-rich plants, lean protein at every meal (including those that also contain fiber, such as nuts and seeds) and a reduction in overall intake of added sugars.”
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“That change will drive true health improvements,” she said.
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