If proposed Medicaid cuts by congressional Republicans are enacted, South Dakota, Missouri, and Oklahoma may face significant challenges due to state constitutional requirements for Medicaid expansion participation. Unlike the majority of states that could modify their Medicaid programs in response to federal funding changes, these three obligated states would have to either amend their constitutions or locate alternative funding solutions, likely through service cuts or tax increases. Recently, various states have seen successful voter-led efforts to secure Medicaid expansion, highlighting a push against opposition to the Affordable Care Act among state-level Republican lawmakers.
If congressional Republicans cut Medicaid expansion funds, South Dakota, Missouri, and Oklahoma face constitutional dilemmas as they are mandated to participate.
Voters in states led by Republican governors have expanded Medicaid through referendums, entrenching health coverage against possible hostility towards the Affordable Care Act.
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