Health

The Three States That Are Especially Stuck if Congress Cuts Medicaid

Published

1 year ago

April 9, 2025

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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Health

Controversial drug delivered rapid relief for severe depression in just hours

Published

3 hours ago

May 30, 2026

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Controversial drug delivered rapid relief for severe depression in just hours

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Health in the kitchen

→ Popular fruit may help protect your skin from the sun, new study suggests

→ Diet change tied to ‘younger’ biological age in older adults

→ Filtered water at specific ages could add months to lifespan decades later

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“The changes in gene expression [from eating grapes] indicated improvements in skin health,” one researcher said. (iStock)

Conversation starters

→ Finding sleep ‘sweet spot’ could help you live longer, study suggests

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This article was written by Fox News staff.

Health

Single infusion of controversial drug changed severe depression symptoms within hours, study finds

Published

14 hours ago

May 29, 2026

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Single infusion of controversial drug changed severe depression symptoms within hours, study finds

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People experiencing severe depression with suicidal symptoms may not have to wait weeks for traditional antidepressants to take effect.

A recent review suggests that a single intravenous ketamine infusion can provide rapid relief for some patients.

Originally developed as an anesthetic, ketamine is a medicine that can reduce pain and, in some cases, help treat depression, but it can also be misused as a recreational drug, experts warn.

SINGLE DOSE OF POWERFUL PSYCHEDELIC CUTS DEPRESSION SYMPTOMS IN CLINICAL STUDY

Researchers from the University of Connecticut School of Medicine reviewed 26 clinical trials that included more than 1,100 patients. Approximately 626 received ketamine and 540 served as controls who did not take the drug.

Most of the trials included patients with major depressive disorder, but 11.5% included those with bipolar depression and 7.7% included people with both unipolar and bipolar depressive diagnoses.

A recent review suggests that a single intravenous ketamine infusion can provide rapid relief for some patients with treatment-resistant depression. (iStock)

Compared to a placebo, a single treatment significantly reduced depression in just four hours and dramatically lowered suicidal thoughts within 24 hours, the study found.

Patients reported fewer depressive symptoms after a week and reduced suicidal thoughts for up to a month after one ketamine infusion. Those who received repeated ketamine infusions showed a similar reduction of suicidal and depressive symptoms at the end of the treatment.

WHAT IS KETAMINE THERAPY? MORMON REALITY STARS TOUT CONTROVERSIAL TREATMENT

The most common adverse effects of ketamine – including headaches, numbness, dissociation (“out of body” experiences), nausea, dizziness and visual disturbances – were temporary and resolved within hours of the infusion.

Rarer, more serious side events included hospitalization, suicide attempts and suicide, but most were unrelated to ketamine, the review stated.

The analysis was published in May in JAMA Psychiatry.

Treatment-resistant depression

Major depressive disorder is a formal psychiatric diagnosis affecting approximately 280 million people globally, according to recent research.

Effective treatment involves a combination of therapy and medication, frequently antidepressants. However, for a few patients, symptoms do not respond to multiple therapies, a condition known as treatment-resistant depression, doctors say.

“When all existing treatment options fail, patients with severe depression could consider ketamine infusions.”

These patients are at a higher risk of very serious, sometimes tragic consequences, including suicidal thoughts, suicide attempts and death.

“When all existing treatment options fail, patients with severe depression could consider ketamine infusions,” lead author Taeho Greg Rhee, PhD, of the University of Connecticut School of Medicine, told Fox News Digital. “This is still a safer option when compared to electroconvulsive therapy (ECT).”

Compared to a placebo, a single treatment significantly reduced depression in just four hours and dramatically lowered suicidal thoughts within 24 hours, the study found. (iStock)

Traditional antidepressants stabilize mood by slowly elevating serotonin levels in the brain, but it can take weeks for the full effect to be achieved.

Ketamine, in contrast, works rapidly by blocking glutamate, a neurotransmitter that can impact emotions negatively when levels are too high in the brain, according to Cleveland Clinic.

Implications for care

The authors say their findings have two important potential clinical applications.

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First, ketamine’s rapid effects can be a life-saving treatment in the emergency room for patients presenting with suicidal ideation.

Experts caution that the medication should only be administered in closely monitored settings, such as clinics, to ensure safe treatment. (iStock)

Second, the effects of a single ketamine infusion are relatively short-lived – as almost all patients relapsed with depressive symptoms after a single infusion – so those with treatment-resistant depression will need repeated sessions.

“While intravenous ketamine is not yet FDA-approved for treating depression, it may still be used with off-label indications for those with severe depression and/or with a high risk of suicidal behaviors,” said Rhee.

Experts urge caution despite promise

Dr. Lama Bazzi, a psychiatrist in private practice in New York City, has had several patients receive ketamine infusions.

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“For a small subset of patients in a major depressive episode or struggling with suicidal thoughts, intravenous ketamine can be genuinely lifesaving,” Bazzi, who was not involved in the study, told Fox News Digital. “The relief they experience is almost immediate, offering them distance from the intensity of their emotions.”

However, she cautions that the medication should only be administered in closely monitored settings, such as clinics, to ensure safe treatment.

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Ketamine is not a panacea, Rhee agreed, warning of the potential risk of abuse and addiction.

“It should only be used medically,” he advised.

Ketamine’s rapid effects can be a life-saving treatment in the emergency room for patients presenting with suicidal ideation, some experts claim. (Getty Images)

Dr. Marc Siegel, Fox News senior medical analyst, noted in previous comments to Fox News Digital that ketamine is increasingly being used to treat severe depression, but emphasized that it should be administered under careful medical supervision because of its potential risks.

Study limitations

Although the studies compared ketamine with a placebo, some patients may have realized they were receiving the drug. This could have influenced how they reported their symptoms and how effective they perceived the treatment to be, according to the researchers.

“It should only be used medically.”

Another limitation is the small sample size of the studies, which could make the effects seem disproportionately magnified.

Also, as this was a review of many different studies, it is challenging to apply the findings to the general population, the researchers noted.

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“While long-term outcomes have not been studied, I believe that when patients are severely depressed or suicidal, ketamine is sometimes the only choice that almost always works,” Bazzi added.

Anyone interested in exploring alternative depression treatments should first consult a doctor.

Health

Tick bite ER visits hit highest seasonal level in years as doctors warn of disease surge

Published

1 day ago

May 29, 2026

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Tick bite ER visits hit highest seasonal level in years as doctors warn of disease surge

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Tick bite-related ER visits are at their highest seasonal levels since 2017 across most U.S. regions, raising concerns about increased Lyme disease and other tick-borne illnesses.

That’s according to recent data from the Centers for Disease Control and Prevention’s Tick Bite Tracker, which monitors weekly emergency department visits associated with tick bites across the country.

For every 100,000 ER visits, approximately 71 were related to tick bites in April 2026, compared to a historical seasonal average of roughly 30 per 100,000.

DOCTORS REVEAL KEY SIGNS OF LYME DISEASE AS TICK SEASON INTENSIFIES ACROSS US

Some of the highest rates of tick-based ER visits were among children younger than 10 years and adults between 70 and 79 years.

A close-up shows a parasitic mite in motion on a human fingertip, highlighting the potential for disease transmission such as encephalitis. (iStock)

“Over the past three decades, the geographic range of the blacklegged tick has expanded significantly, and with it, the risk of Lyme disease and other Ixodes-transmitted infections,” Dr. Steven Goldberg, a family medicine physician who practices urgent care and family medicine at UofLHealth in Louisville, Kentucky, told Fox News Digital.

‘RABBIT FEVER’ CASES RISING IN US AS CDC WARNS OF ZOONOTIC BACTERIAL DISEASE

“The Ohio River Valley region is one of the most striking examples — Lyme disease cases in Ohio have increased roughly 10-fold over the past decade, likely driven by the convergence of Northeastern and Upper Midwestern tick populations meeting in that corridor.”

States like Virginia and West Virginia, as well as areas south of the traditional endemic zone, are reporting increasing tick abundance and disease cases, the doctor noted.

“Over the past three decades, the geographic range of the blacklegged tick has expanded significantly.”

“The lone star tick is also expanding its range northward beyond its traditional stronghold in the Southeast, which means diseases like ehrlichiosis and alpha-gal syndrome are appearing in regions where clinicians may not yet be thinking about them,” he warned.

Some climate studies predict that the blacklegged tick’s suitable habitat could expand by over 200% by the end of the century, Goldberg noted, including into Canada and across the central and southern U.S.

What’s driving the spike?

“Warmer, wetter conditions allow ticks to survive in habitats that previously would have been too cold,” said Dr. Suraj Saggar, chief of infectious disease at Holy Name Medical Center in Teaneck, New Jersey. “Milder winters also extend the lifespan of both ticks and the animals they feed on, accelerating tick reproduction and shortening their life cycles.”

Areas that historically experienced longer, colder winters or significant snow cover are now more hospitable to ticks, the doctor noted.

COPPERHEAD SNAKE BITE LEAVES MAYOR’S WIFE IN ‘EXCRUCIATING PAIN,’ HE REVEALS

“As temperatures rise and precipitation patterns change, ticks are able to spread northward and thrive in new ecosystems,” he said.

Another contributing factor is increased land development and human expansion into wooded and grassy areas, as well as reforestation of formerly agricultural land.

“As temperatures rise and precipitation patterns change, ticks are able to spread northward and thrive in new ecosystems,” an expert said. (iStock)

“The recovery and expansion of white-tailed deer populations — critical hosts for adult blacklegged ticks — has been a major driver,” Goldberg added. “Deer density is positively associated with Lyme disease incidence. Small mammal communities, particularly white-footed mice that serve as key reservoir hosts for Borrelia burgdorferi, also play a central role.”

Tick-borne diseases

Tick bites are known to transmit numerous illnesses, the most widespread of which is Lyme disease, a bacterial infection.

“Lyme disease cases alone have increased roughly two- to threefold over the past 20 years,” Saggar said. Approximately 476,000 Americans are diagnosed and treated for Lyme disease each year, per CDC surveillance data.

MOSQUITO-BORN DENGUE FEVER CASES SURGE AT POPULAR US VACATION DESTINATION

Also common are anaplasmosis and ehrlichiosis, two different types of bacterial infections, according to the doctor. Tick bites can also cause babesiosis, a malaria-like parasitic disease that infects and destroys red blood cells.

“Another growing concern is alpha-gal syndrome, a condition in which a (lone star) tick bite triggers a serious allergic reaction to red meat,” Saggar said. “In rare cases, people have died from anaphylactic reactions linked to alpha-gal syndrome following a tick bite.”

Some common symptoms of tick-borne illness include fever, chills, fatigue, headaches, muscle aches and joint pain. (iStock)

Ticks can also transmit viruses, including the Powassan virus, which can cause severe neurologic injury.

“Powassan virus disease is arguably the most concerning emerging tick-borne infection,” said Goldberg, who is also chief medical officer at HealthTrack. “It’s transmitted by the same blacklegged tick that carries Lyme disease, but unlike Lyme, it can be transmitted within minutes of tick attachment.”

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Powassan can cause severe encephalitis with a roughly 10% to 15% fatality rate, and more than half of survivors have lasting neurological deficits, Goldberg noted.

In the Rocky Mountain states, the Rocky Mountain wood tick (Dermacentor andersoni) transmits Rocky Mountain spotted fever and Colorado tick fever.

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“In the Southeast and South-Central U.S., the lone star tick (Amblyomma americanum) drives a different set of concerns: ehrlichiosis, tularemia, and two emerging viral threats — Heartland virus and Bourbon virus,” said Goldberg.

Symptoms to watch for

Some common symptoms of tick-borne illness include fever, chills, fatigue, headaches, muscle aches and joint pain, according to Saggar.

Another sign is the classic “bull’s-eye” rash associated with Lyme disease, known medically as “erythema migrans.”

“If you think you have been bitten by a tick, you should seek medical attention if you develop symptoms after a known tick bite or after spending time in tick-prone areas, especially during the spring, summer and fall.” (iStock)

“Because testing can sometimes be falsely negative early in the disease process, doctors may treat patients based on symptoms and exposure history rather than waiting for laboratory confirmation,” Saggar noted.

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Preventing tick bites

As there are no vaccines currently available for any tick-borne disease in the U.S., prevention is the most effective strategy.

Goldberg shared the following recommended prevention strategies.

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Use EPA-approved repellents, including DEET, picaridin, IR3535 or oil of lemon eucalyptus on exposed skin. Treat clothing and gear with permethrin (a synthetic insecticide and repellent) or purchase pre-treated clothing.
Wear light-colored clothing (to spot ticks more easily), long sleeves and long pants tucked into socks when in wooded or grassy areas.
After spending time outdoors, check your entire body, paying special attention to the scalp, behind the ears, armpits, groin and behind the knees, the doctor advised. It’s also recommended to shower within two hours of coming indoors.
Tumble-dry clothing on high heat for at least 10 minutes to kill any ticks on clothing.
Remove ticks promptly and properly. Using fine-tipped tweezers, grasp the tick as close to the skin as possible, and pull upward with steady, even pressure. Clean the bite area afterward.

Approximately 476,000 Americans are diagnosed and treated for Lyme disease each year, per CDC data.

“The longer a tick is attached, the higher the risk of disease transmission — for Lyme disease, transmission generally requires at least 36 hours of attachment,” Goldberg said. “The Powassan virus can be transmitted much more quickly.”

Melissa Rudy is senior health editor and a member of the lifestyle team at Fox News Digital. Story tips can be sent to melissa.rudy@fox.com.