The three states that are particularly stuck if the Cup Cup Medicaid

If the Republicans of the Congress passed with some of the deep cups of Medicaid that they envisage, three states would be left in a particularly tight connection.

South Dakota, Missouri and Oklahoma have statements of state requiring that they participate in the expansion of Medicaid, the part of Obamacare that has expanded the health program for the poor to millions of adults.

If the Republicans choose to make the projected budget reductions by reducing the expansion of Medicaid, the 37 other states (and DC) which participate in the expansion could cease to cover the adults of the working class. Nine states have laws that explicitly force them to stop the expansion of Medicaid or to make significant changes if the federal share of expenses decreases.

But southern Dakota, Missouri and Oklahoma cannot do that. They must either modify their constitutions, a long process that can take years, or determine how to fill the budgetary hole, probably by reducing other services or increasing taxes.

The constitutional amendments were deposited on state ballots by the state by progressive activists, who wanted to subtract the Medicaid program in places hostile to this part of the affordable care law. The idea was twofold: obtaining health coverage for more people and attaching more states and their republican legislators in Medicaid.