On Sunday’s edition of Meet the Press, Senator Markwayne Mullin (R-OK) called for sweeping reform of the Medicaid program, citing stark disparities in enrollment versus poverty levels. “We are cutting the waste, fraud and abuse, and I want to use the word abuse,” Mullin said. “There’s 35 million people that live under the poverty line inside the United States, yet 70 million on Medicaid — it is unsustainable.”
Mullin argued that Medicaid, originally designed to aid the most vulnerable, has expanded far beyond its intended reach. He emphasized the importance of ensuring that the program truly serves those in need. “Medicaid was designed for those in the most dire need, and we need to make sure it is there,” he stated.
A central issue Mullin highlighted is the uneven use of provider taxes by states to meet federal match requirements. “Ever since Obamacare, there has been this loophole that allows the states to charge providers an exorbitant amount to pay their share,” he explained. These taxes, levied on hospitals and clinics, are passed on to Medicaid, inflating federal expenditure. Mullin emphasized that states like North Carolina and California impose especially high provider taxes, necessitating offsetting contributions from taxpayers in lower-tax states like Oklahoma.
Mullin proposed establishing uniform provider tax rates across all states and progressively lowering the total burden. This would create a level fiscal playing field and prevent wealthier states from imposing undue federal costs.
Medicaid spending constitutes nearly a quarter of all federal spending, with significant variability across states. According to the Kaiser Family Foundation, per-enrollee costs range from approximately $3,000 in states like Utah to over $10,000 in Alaska, driven in part by differing tax structures and population health needs. Reform advocates warn that unchecked expansion and complexity could threaten both the program’s fiscal sustainability and its ability to deliver quality care.
Medicaid reform remains a divisive issue on Capitol Hill. Democrats generally defend the program’s expansion, citing benefits such as improved preventative care and reduced uncompensated hospital costs. Republicans, including Mullin, argue that targeted reforms are necessary to curb misuse and protect the program’s integrity. Any alterations to Medicaid will require bipartisan negotiation and regulatory revisions through Congress and the Centers for Medicare & Medicaid Services (CMS).
