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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The first oral GLP-1 medication for weight loss has been approved for use in the U.S.
The Wegovy pill, from drugmaker Novo Nordisk, was cleared by the Food and Drug Administration to reduce excess body weight, maintain long-term weight reduction and lower the risk of major cardiovascular events.
Approval of the once-daily 25mg semaglutide pill was based on the results of two clinical trials — the OASIS trial program and the SELECT trial.
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The Wegovy pill demonstrated a mean weight loss of 16.6% in the OASIS 4 trial among adults who were obese or overweight and had one or more comorbidities (other medical conditions), according to a press release. In the same trial, one in three participants experienced 20% or greater weight loss.
The first oral GLP-1 medication for weight loss has been approved for use in the U.S. (iStock)
Novo Nordisk reported that the weight loss achieved with the pill is similar to that of injectable Wegovy and has a similar safety profile.
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“With today’s approval of the Wegovy pill, patients will have a convenient, once-daily pill that can help them lose as much weight as the original Wegovy injection,” said Mike Doustdar, president and CEO of Novo Nordisk, in the press release.
Novo Nordisk reported that the weight loss achieved with the pill is similar to that of injectable Wegovy and has a similar safety profile. (James Manning/PA Images via Getty Images)
“As the first oral GLP-1 treatment for people living with overweight or obesity, the Wegovy pill provides patients with a new, convenient treatment option that can help patients start or continue their weight-loss journey.”
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The oral GLP-1 is expected to launch in the U.S. in early January 2026. Novo Nordisk has also submitted oral semaglutide for obesity to the European Medicines Agency (EMA) and other regulatory authorities.
“Most side effects will be GI-related and should be similar to the injectable, such as nausea, vomiting and constipation,” an expert said. (iStock)
Dr. Sue Decotiis, a medical weight-loss doctor in New York City, confirmed in an interview with Fox News Digital that studies show oral Wegovy is comparable to the weekly injectable, just without the needles.
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Although the pill may result in better compliance and ease of use, Decotiis warned that some patients may not absorb the medication through the gastrointestinal tract as well as with the injectable version due to individual idiosyncrasies in the body.
“Most side effects will be GI-related and should be similar to the injectable, such as nausea, vomiting and constipation,” she said.
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“In my practice, I have found tirzepatide (Mounjaro and Zepbound) to yield more weight loss and fat loss than semaglutide by about 20%,” the doctor added. “This has been shown in studies, often [with] fewer side effects.”
More oral GLP-1s may be coming in 2026, according to Decotiis, including an Orforglipron application by Lilly and a new combination Novo Nordisk drug, which is pending approval later next year.
One expert warned that some patients may not absorb the medication through the gastrointestinal tract as well as with the injectable version. (iStock)
“There will be more new drugs available in the future that will be more effective for patients who are more insulin-resistant and have not responded as well to semaglutide and/or tirzepatide,” the doctor said. “This is great news, as novel drugs affecting more receptors mean better long-term results in more patients.”
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As these medications become cheaper and easier to access, Decotiis emphasized that keeping up with healthy lifestyle habits — including proper nutrition with sufficient protein and fiber, as well as increased hydration — is essential to ensuring lasting results.
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“If not, patients will regain weight and could lose muscle and not enough body fat,” she said.
Fox News Digital reached out to Novo Nordisk for comment.
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A study from Sweden’s Uppsala University discovered a link between microplastics and multiple sclerosis (MS).
The research, published in the journal Environmental International, discovered that exposure to two common environmental contaminants, PFAS and PCBs, could increase the risk of the autoimmune disease.
PFAS, or per- and polyfluoroalkyl substances, known as “forever chemicals,” are used in some common household products, such as non-stick cookware, textiles and cleaning products. They have also been found in drinking water throughout the U.S., according to the U.S. Environmental Protection Agency.
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PCBs, or polychlorinated biphenyls, are toxic industrial chemicals once widely used in electrical equipment before being banned decades ago, as stated by the National Institute of Environmental Health Sciences.
The new study findings were based on blood samples of 1,800 Swedish individuals, including about 900 who had recently been diagnosed with MS, according to a university press release.
PFAS, or per- and polyfluoroalkyl substances, known as “forever chemicals,” are used in some common household products, including non-stick cookware. (iStock)
The first phase of the trial studied 14 different PFAS contaminants and three substances that appear when PCBs are broken down in the body. These were then investigated for a link to the odds of diagnosis.
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“We saw that several individual substances, such as PFOS and two hydroxylated PCBs, were linked to increased odds for MS,” lead study author Kim Kultima said in a statement. “People with the highest concentrations of PFOS and PCBs had approximately twice the odds of being diagnosed with MS, compared to those with the lowest concentrations.”
The researchers then examined the combined effects of these substances and found that the mixture was also linked to increased risk.
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Fellow researcher Aina Vaivade noted that risk assessments should consider chemical mixtures, not just individual exposures, because people are typically exposed to multiple substances at the same time.
“We saw that several individual substances, such as PFOS and two hydroxylated PCBs, were linked to increased odds for MS,” the lead study author said. (iStock)
The final phase of the study investigated the relationship between inheritance, chemical exposure and the odds of MS diagnosis, revealing that those who carry a certain gene variant actually have a reduced MS risk.
However, individuals who carried the gene and had higher exposure to PFOS — a singular type of chemical in the PFAS family — had an “unexpected” increased risk of MS.
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“This indicates that there is a complex interaction between inheritance and environmental exposure linked to the odds of MS,” Kultima said.
“We therefore think it is important to understand how environmental contaminants interact with hereditary factors, as this can provide new knowledge about the genesis of MS and could also be relevant for other diseases.”
Multiple sclerosis is a disease that leads to the breakdown of the protective covering of the nerves, according to Mayo Clinic. (iStock)
Fox News senior medical analyst Dr. Marc Siegel commented on these findings in an interview with Fox News Digital.
“MS is a complex disease that is somewhat autoimmune and somewhat post-inflammatory,” said Siegel, who was not involved in the study. “Epstein-Barr virus infection greatly increases the risk of MS.”
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“There is every reason to believe that environmental triggers play a role, including microplastics, and this important study shows a correlation, but not causation — in other words, it doesn’t prove that the microplastics caused MS.”
The study had some limitations, the researchers acknowledged, including that the chemical exposure was measured only once, at the time of blood sampling. This means it may not accurately represent participants’ long-term or past exposure levels relevant to MS development.
“There is every reason to believe that environmental triggers play a role.”
Fox News Digital reached out to several industry groups and manufacturers requesting comment on the potential link between PFAS chemicals and multiple sclerosis.
Several have issued public statements, including the American Chemistry Council, which states on its website that “manufacturers and many users of today’s PFAS are implementing a variety of practices and technologies to help minimize environmental emissions.”
In April 2024, the EPA enacted a new federal rule that sets mandatory limits on certain PFAS chemicals in drinking water, aiming to reduce exposure. The agency also aims to fund testing and treatment efforts.
A woman working out outdoors takes a sip of water from a plastic bottle. (iStock)
Multiple sclerosis is a disease that leads to the breakdown of the protective coverings that surround nerve fibers, according to Mayo Clinic.
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The immune system’s attack on these nerve sheaths can cause numbness, weakness, trouble walking and moving, vision changes and other symptoms, and can lead to permanent damage.
There is currently no cure for MS, Mayo Clinic reports, but treatment is available to manage symptoms and modify the course of the disease.
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