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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Texas health officials are sounding the alarm on a surge of a common childhood illness.
The Texas Department of State Health Services (DHSH) revealed this week that there are nearly four times the number of whooping cough cases in the state compared to this time last year.
According to provisional data, Texas has had over 3,500 cases of whooping cough, also called pertussis, through October 2025.
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This is the second year in a row the state has reported high increases in cases and the second year in a row a health alert has been issued, according to DHSH.
Children under 12 months are most at risk, although anyone can catch pertussis. (iStock)
Pertussis is a highly contagious respiratory infection caused by the bacterium Bordetella pertussis, according to the National Institute of Allergy and Infectious Diseases.
It begins like a common cold, with a runny nose, sneezing and mild cough, but over time progresses to intense coughing fits that may end in a high-pitched “whoop” as the person gasps for air.
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The illness typically goes through three stages: cold-like symptoms, violent coughs and then gradual recovery, according to the Cleveland Clinic.
Experts say testing, treatment and timely vaccination remain the best defenses against whooping cough. (iStock)
While anyone can get whooping cough, complications are most severe in babies 12 months and under. Infants are more likely to be hospitalized and face even greater risk if they are immunocompromised or not vaccinated.
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In babies, the symptoms may not include the classic “whoop” sound. Instead, they may struggle to breathe or pause in breathing, the Cleveland Clinic says.
Cases this year are quadruple the number seen last year at this time in Texas, officials say. (iStock)
Teenagers and adults can also catch it, often because vaccine protection has faded. They typically experience milder symptoms.
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The CDC recommends pertussis vaccinations for all ages, and Texas health leaders stress that everyone should stay up to date to prevent fading immunity.
Pregnant women are advised to receive a Tdap shot during each pregnancy, ideally between 27 and 36 weeks, to help protect newborns, while adults in close contact with infants should also be vaccinated at least two weeks before exposure, health officials say.
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Clinicians are encouraged to test anyone showing symptoms consistent with pertussis, though treatment can begin based on “strong clinical suspicion” or exposure. PCR tests are preferred because they are quick and widely available.
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Early treatment — regardless of vaccination history — is key to preventing severe illness and stopping spread, officials say.
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While gastroesophageal reflux disease (GERD) affects both men and women, men tend to experience more severe symptoms and complications.
Studies show that men have higher acid exposure and are nearly twice as likely to develop Barrett’s esophagus, a condition that can lead to esophageal cancer if left untreated.
Esophageal cancer is up to nine times more common in men, making them far more likely to progress from chronic reflux to serious outcomes.
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Dr. Daryl Gioffre, gut health specialist, certified nutritionist and author of “Get Off Your Acid” and “Get Off Your Sugar,” spoke with Fox News Digital about how acid reflux is becoming a “silent epidemic” among men — and what they can do about it.
“This isn’t just about heartburn, but about systemic inflammation that starts in the gut and spreads throughout the body,” Gioffre said.
While gastroesophageal reflux disease (GERD) affects both men and women, men tend to experience more severe symptoms and complications. (iStock)
“Acid reflux is the body’s alarm system, warning that the gut, metabolism and stress response are all out of balance.”
‘The perfect storm’
Men today are living in a “pressure cooker,” Gioffre warned. “Chronic stress, poor sleep, processed foods, alcohol and medication overuse are destroying gut health and digestion,” he said.
“Combine that with typical diets heavier in meat, alcohol and ultraprocessed foods, and a greater tendency to ignore symptoms, and you’re breeding a perfect storm for chronic inflammation and increased risk of reflux compared to women.”
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Late-night eating, larger portions, less fiber and high caffeine intake also stack the deck against men, he said. In addition to dietary choices, men’s lifestyle behaviors can also impact digestion.
Late-night eating and larger portions are part of what make men more prone to acid reflux and other digestive issues. (iStock)
“Many men skip meals, eat too quickly and rely on convenience foods stripped of minerals and fiber,” Gioffre said.
Over time, this “ongoing acid assault” erodes the gut lining, drives acid upward and turns normal esophageal cells into precancerous Barrett’s cells, increasing cancer risk dramatically, he warned.
Biggest food culprits
When it comes to ultraprocessed foods, Gioffre called out three specific components that worsen acid reflux: refined salt, sugar and seed oils.
“Together, they inflame the gut and weaken both digestion and the lower esophageal sphincter, the valve that keeps acid in the stomach where it belongs,” he said.
“Men need to slow down, eat foods that support digestion and strengthen the gut, and stop relying on quick fixes.”
Men also tend to drink more coffee than women, often two to three cups a day, usually on an empty stomach, Gioffre pointed out.
“That constant caffeine hit strips minerals, dehydrates the body and spikes acidity — all of which increase the risk of reflux.”
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Ultimately, he said, “men need to slow down, eat foods that support digestion and strengthen the gut, and stop relying on quick fixes. Otherwise, reflux will only keep getting worse and harder to treat.”
Biological differences
There are some biological differences between the genders that contribute to men’s higher risk of severe gastrointestinal conditions, according to Gioffre.
“Men produce less protective mucus and saliva — the body’s natural defense system that buffers acid when it backflows into the esophagus. So when acid reflux strikes, it hits harder,” he said.
Some examples of alkaline-rich foods include leafy greens, vegetables, fruits, nuts and seeds, and mineral water or spring water. (iStock)
“That acid burns and erodes tissue that was never designed to handle acid in the first place, setting the stage for inflammation, damage and long-term complications.”
Younger men also tend to carry more visceral (abdominal) fat, Gioffre noted, which increases pressure in the stomach and forces acid up into the esophagus.
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Hormones also play a role.
“Estrogen in women appears to protect the esophagus by improving blood flow and mucosal repair, protection men have much less of,” the doctor said. “Without lower levels than women, their tissue where reflux hits doesn’t recover as quickly from repeated acid exposure.”
7 things to start doing right now
Gioffre recommends that men take the following simple steps to immediately begin lowering their risk.
No. 1: Stop eating three hours before bed
“One of the biggest and most overlooked causes of acid reflux is eating too close to bedtime,” Gioffre said. “When you lie down after a meal, gravity is no longer helping to keep acid in your stomach where it belongs, so it’s much easier for it to travel up the wrong way into your esophagus.”
Reflux symptoms often get worse at night, the doctor noted — “and it’s why so many men wake up coughing, choking or with a burning throat, hoarse voice or sour taste in their mouth.” (iStock)
This is why reflux symptoms often get worse at night, he noted — “and it’s why so many men wake up coughing, choking or with a burning throat, hoarse voice or sour taste in their mouth.”
Gioffre said it’s best to stop eating three hours before bed, which gives the body time to fully digest, empty the stomach and drop acid levels before lying down.
No. 2: Remove common reflux triggers
Common triggers include garlic, onions, spicy foods, alcohol, chocolate, caffeine, citrus fruits and carbonated water, according to Gioffre.
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“All of these weaken the lower esophageal sphincter, the valve that keeps stomach acid where it belongs,” he said. “Once that muscle relaxes, acid flows upward, causing heartburn by inflaming and irritating the esophageal and throat lining.”
“If you want to heal reflux naturally, you can’t just change what you eat — you have to change how you live.”
The doctor also recommends adding back alkaline minerals, digestive enzymes and a high-quality probiotic. Some examples of alkaline-rich foods include leafy greens, vegetables, fruits, nuts and seeds, and mineral water or spring water.
No. 3: Stay hydrated
Gioffre recommends starting the morning with warm lemon water with a teaspoon of local honey, or a tea with slippery elm.
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“This helps soothe and calm the upper GI tract and eases reflux,” he said. It’s also important to stay hydrated throughout the day, the doctor added.
No. 4: Stay grounded
Simple grounding practices, like walking barefoot in the grass, doing deep breathing or just stepping outside to reconnect with nature, can help promote gut health.
Esophageal cancer is up to nine times more common in men, making them far more likely to progress from chronic reflux to serious outcomes. (iStock)
“These activate your parasympathetic ‘rest-and-digest’ system, calm your gut and keep acid levels in check naturally,” Gioffre said. “Get outside and move after meals, and swap your late-night snack for deep breathing or stretching.”
No. 5: Manage stress and sleep
When men don’t sleep well, the body produces more cortisol, which is the main stress hormone.
“High cortisol keeps you locked in a constant state of fight-or-flight, and when you’re in that mode, your body isn’t focused on rest, digest or repair — it’s focused on survival,” Gioffre said.
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In this state, blood flow is pulled away from the gut and sent to the muscles and brain, he noted, which means digestion slows down, stomach acid production drops and food sits in the stomach for too long, which leads to bloating, gas and more reflux.
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“If you want to heal reflux naturally, you can’t just change what you eat — you have to change how you live,” Gioffre said. “Quality sleep and stress management are non-negotiable if you want to restore your gut and calm acid at its root cause.”
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An experimental drug has shown promise in fighting a hard-to-treat form of bladder cancer known as BCG-unresponsive high-risk non-muscle-invasive bladder cancer (NMIBC).
BCG (Bacillus Calmette-Guérin) is an immunotherapy drug that is often the first-line treatment for certain early-stage bladder cancers.
The new drug, TAR-200 — which was evaluated in a trial sponsored and conducted by Janssen Research & Development, LLC, a subsidiary of Johnson & Johnson — may offer a less invasive alternative to bladder removal surgery.
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TAR-200 is a small, drug-releasing device placed directly into the bladder through a simple outpatient procedure, without general anesthesia, according to the study press release.
Once inserted, it slowly releases the chemotherapy drug gemcitabine over several weeks.
Researchers say the new bladder-inserted device could spare patients from losing their bladder entirely. (iStock)
“Traditionally, these patients have had very limited treatment options. This new therapy is the most effective one reported to date for the most common form of bladder cancer,” said study lead Sia Daneshmand, M.D., director of urologic oncology with Keck Medicine of USC, in a press release.
“The findings of the clinical trial are a breakthrough in how certain types of bladder cancer might be treated, leading to improved outcomes and saved lives.”
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Bladder cancer is the fourth most common cancer in men and the 11th most common cancer in women.
According to the Urology Care Foundation, non-muscle-invasive bladder cancer is found in the tissue that lines the inner surface of the bladder.
“Bladder cancer is one of the 10 most common cancers worldwide, yet treatment options have remained largely unchanged for over 40 years.”
High-risk NMIBC carries a greater chance of coming back after treatment. This study aimed to find an option for patients whose cancer recurred even after standard therapy.
“The standard treatment plan for these patients was surgery to remove the bladder and surrounding tissue and organs, which has many health risks and may negatively impact patients’ quality of life,” said Daneshmand.
This new therapy could eventually allow some patients to avoid that procedure.
Trial results showed that many patients stayed cancer-free for more than two years. (iStock)
All participants in the study had high-risk NMIBC that did not respond to the standard immunotherapy drug BCG. The study was split into multiple groups who tested different combinations of drugs and treatment methods.
In one group, patients received TAR-200 once every three weeks for about six months, followed by maintenance treatments every 12 weeks for up to two years.
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Among 85 patients in this group, 82.4% showed no detectable signs of cancer after treatment. In that group, 52.9% remained cancer-free at one year, and many stayed cancer-free for more than two years without needing additional therapy.
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In another group of patients with a less aggressive type of early-stage bladder cancer, early disease-free survival rates were 85.3% at six months and 81.1% at nine months. Overall, 94% were able to keep their bladders.
The clinical trial results were published earlier this year in the Journal of Clinical Oncology.
The TAR-200 device delivers gemcitabine directly to the bladder, keeping the drug where it’s needed most. (iStock)
The researchers emphasized that this is still mid-stage (Phase 2b) data. Longer-term, larger trials and regulatory reviews are still needed before the treatment could become standard care.
“Because the study didn’t include a traditional comparison (no randomized control arm), we can’t definitively say how TAR-200 stacks up against other treatments in a fair head-to-head way,” the researchers wrote.
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Patients in this study are a specific subset (BCG-unresponsive and eligible for bladder preservation) and may not represent all bladder-cancer cases.
“Also, follow-up time remains relatively short and the number of patients modest, meaning we don’t yet know how long the benefits will last or how they apply to larger, more diverse groups of people,” the researchers added.
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