States that were once reluctant to expand Medicaid now have their state budgets tied to the fate of the program by constitutional amendments.According to The New York Times, several states that were initially hesitant to expand Medicaid under the Affordable Care Act are now facing a potential budget crisis due to their constitutional amendments tying their state budgets to the fate of the program.
If congressional Republicans follow through with their proposed deep cuts to Medicaid, three states in particular – South Dakota, Missouri, and Oklahoma – will be in a difficult position. These states have state constitutions that require them to participate in Medicaid expansion, which extended health coverage to millions of low-income adults.
If the budget reductions are made by cutting into Medicaid expansion, the other 37 states (and Washington D.C.) that have already expanded the program could choose to stop covering working-class adults. However, nine states have laws in place that would require them to stop Medicaid expansion or make significant changes if the federal share of spending decreases.
The three states mentioned earlier, however, do not have this option. They would either need to amend their constitutions, which is a lengthy process, or find other ways to fill the budget gap – most likely by cutting other services or raising taxes.
These constitutional amendments were put on state ballots by progressive activists who wanted to solidify the Medicaid program in states that had previously been opposed to it. The goal was to provide health coverage to more people and also hold more states and their Republican lawmakers accountable for the success of Medicaid.
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