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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What if your New Year’s resolution could fit inside a tote bag? Social media users are trying the “analog bag” trend, replacing phones with offline activities.
The trend is widely credited to TikTok creator Sierra Campbell, who posted about her own analog bag — containing a crossword book, portable watercolor set, Polaroid camera, planner and knitting supplies — and encouraged followers to make their own.
Her video prompted many others to share their own versions, with items like magazines, decks of cards, paints, needlepoint and puzzle books.
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“I made a bag of non-digital activities to occupy my hands instead of the phone,” said Campbell, adding that the practice has significantly cut her screen time and filled her life with “creative and communal pursuits that don’t include doom-scrolling.”
“I created the analog bag after learning the only way to change a habit is to replace it with another,” she told Fox News Digital.
Social media users are trying the “analog bag” trend, replacing phones with offline activities like cameras, notebooks and magazines. (Fox News Digital)
The science of healthier habits
Research on habit formation supports the idea of the analog bag, according to Dr. Daniel Amen, a California-based psychiatrist and founder of Amen Clinics.
“Your brain is a creature of habit,” Amen said during an interview with Fox News Digital. “Neurons that fire together wire together, meaning that every time you repeat a behavior, whether it’s good or bad, you strengthen the neural pathways that make it easier to do it again.”
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Studies show that habits are automatic responses to specific cues — such as boredom, stress or idle time — that typically deliver some kind of reward, according to the doctor. When no alternative behavior is available, people tend to fall back on the same routine, often without realizing it.
Research suggests that replacing an old habit with a new one tied to the same cue is more effective than trying to suppress the behavior altogether.
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“[When] cutting out coffee — you need to have another drink to grab for, not just quit cold turkey. It’s how the pathways in our brains work,” Campbell said.
By substituting a different routine that still provides stimulation and engagement, people can gradually weaken the original habit and build a new automatic response.
Substituting another activity instead of scrolling on your phone can help quell the impulse to reach for it. (iStock)
“Simply stopping a behavior is very challenging,” Amen said. “Replacing one habit with something that is better for your brain is much easier. That’s how lasting change happens, one step at a time.”
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If alternatives are within arm’s reach, people will be more likely to use them, the doctor said. “Your brain does much better with small, simple actions than big, vague intentions.”
Instead of saying, “I’ll stop scrolling today,” the doctor recommends choosing a small habit you can do in a few moments in specific situations, like knitting 10 rows of a scarf on your commute or reading a few pages of a book while waiting at the doctor’s office.
“If alternatives are within arm’s reach, you’re more likely to use them,” a brain doctor said. “Your brain does much better with small, simple actions than big, vague intentions.” (iStock)
Campbell shared her own examples of how to use an analog bag. At a coffee shop with friends, she said, she might pull out a crossword puzzle and ask others to help with answers when the conversation lulls.
Instead of taking dozens of photos on her phone, she uses an instant camera, which limits shots and encourages more intentional moments.
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In casual outdoor settings, such as a park or winery, she brings a small watercolor set for a quick creative outlet.
“It’s brought so much joy,” Campbell said of the analog bag trend, “seeing how it resonates with so many.”
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A deadly, drug-resistant fungus already spreading rapidly through U.S. hospitals is becoming even more threatening worldwide, though there may be hope for new treatments, according to a new scientific review.
Candida auris (C. auris), often described as a “superbug fungus,” is spreading globally and increasingly resisting human immune systems, Hackensack Meridian Center for Discovery and Innovation (CDI) researchers said in a review published in early December.
The findings reinforce prior CDC warnings that have labeled C. auris an “urgent antimicrobial threat” — the first fungal pathogen to receive that designation — as U.S. cases have surged, particularly in hospitals and long-term care centers.
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Approximately 7,000 cases were identified across dozens of U.S. states in 2025, according to the CDC, and it has reportedly been identified in at least 60 countries.
Candida auris is a drug-resistant fungus spreading in hospitals worldwide. (Nicolas Armer/Picture Alliance via Getty Images)
The review, published in Microbiology and Molecular Biology Reviews, helps explain why the pathogen is so difficult to contain and warns that outdated diagnostics and limited treatments lag behind. It was conducted by Dr. Neeraj Chauhan of the Hackensack Meridian CDI in New Jersey, Dr. Anuradha Chowdhary of the University of Delhi’s Medical Mycology Unit and Dr. Michail Lionakis, chief of the clinical mycology program at the National Institutes of Health.
Their findings stress the need to develop “novel antifungal agents with broad-spectrum activity against human fungal pathogens, to improve diagnostic tests and to develop immune- and vaccine-based adjunct modalities for the treatment of high-risk patients,” the researchers said in a statement.
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“In addition, future efforts should focus on raising awareness about fungal disease through developing better surveillance mechanisms, especially in resource-poor countries,” they added. “All these developments should help improve the outcomes and prognosis of patients afflicted by opportunistic fungal infections.”
Candida auris can survive on skin and hospital surfaces, allowing it to spread easily. (iStock)
First identified in 2009 from a patient’s ear sample in Japan, C. auris has since spread to dozens of countries, including the U.S., where outbreaks have forced some hospital intensive care units to shut down, according to the researchers.
The fungus poses the greatest risk to people who are already critically ill, particularly those on ventilators or with weakened immune systems. Once infected, about half of patients may die, according to some estimates.
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Unlike many other fungi, C. auris can survive on human skin and cling to hospital surfaces and medical equipment, allowing it to spread easily in healthcare settings.
“It is resistant to multiple antifungal drugs, and it tends to spread in hospital settings, including on equipment being used on immunocompromised and semi-immunocompromised patients, such as ventilators and catheters,” Dr. Marc Siegel, Fox News senior medical analyst and clinical professor of medicine at NYU Langone, previously told Fox News Digital.
Scientists say the unique cell wall structure of C. auris makes it harder to kill. (iStock)
It is also frequently misdiagnosed, delaying treatment and infection control measures.
“Unfortunately, symptoms such as fever, chills and aches may be ubiquitous, and it can be mistaken for other infections,” Siegel said.
In September, he said intense research was ongoing to develop new treatments.
Only four major classes of antifungal drugs are currently available, and C. auris has already shown resistance to many of them. While three new antifungal drugs have been approved or are in late-stage trials, researchers warn that drug development has struggled to keep pace with the fungus’s evolution.
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Despite the sobering findings, there is still room for cautious optimism.
The fungus can cling to skin and hospital surfaces, aiding its spread. (iStock)
In separate research published in December, scientists at the University of Exeter in England discovered a potential weakness in C. auris while studying the fungus in a living-host model.
The team found that, during infection, the fungus activates specific genes to scavenge iron, a nutrient it needs to survive, according to their paper, published in the Nature portfolio journal Communications Biology in December.
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Because iron is essential for the pathogen, researchers believe drugs that block this process could eventually stop infections or even allow existing medications to be repurposed.
“We think our research may have revealed an Achilles’ heel in this lethal pathogen during active infection,” Dr. Hugh Gifford, a clinical lecturer at the University of Exeter and co-author of the study, said in a statement.
New research is underway to develop better treatments and diagnostics for C. auris. (iStock)
As researchers race to better understand the fungus, officials warn that strict infection control, rapid detection and continued investment in new treatments remain critical.
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Health experts emphasize that C. auris is not a threat to healthy people.
Fox News Digital has reached out to the CDI researchers and additional experts for comment.
Fox News Digital’s Angelica Stabile contributed reporting.
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