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The reduction, KFF found, is likely reflecting recent state budget challenges and the significant costs associated with coverage. Medicaid cuts within President Donald Trumps omnibus tax and spending bill could further exacerbate existing cost concerns, KFFs survey found (On the federal side, the Trump administration has sent mixed signals on GLP-1s, walking back a planned public coverage expansion in the spring but cutting a deal with drugmakers to expand Medicare access in the fall.) Still, the cost pressure of these drugs is acute in Pennsylvania, where lawmakers needed 135 extra days to cut a budget deal in part due to the states increasingly tough financial picture