Sunflower State News

U.S. Senator Roger Marshall, M.D. (R-Kansas) published an opinion piece in Newsweek on June 27, 2025, discussing the current state of Medicaid and efforts by Republicans to reform the program. In his op-ed, Marshall draws from his experience as an OB-GYN in rural Kansas, noting that he delivered many babies covered by Medicaid and often provided care without reimbursement.

Marshall writes, "As an OB-GYN in rural Kansas, I delivered a baby almost every day for over 25 years. About half of these deliveries were on Medicaid, and another 10 to 20 percent were done without reimbursement. Every doctor in our community, and our hospital, took all comers; no one was turned away based on their ability to pay. We thought it was our duty, our obligation to society. It’s why we wanted to become doctors: to serve our fellow human beings. All this despite no increase in reimbursement from Medicaid in my 25 years of practicing medicine."

He criticizes the effectiveness of Medicaid coverage, stating that having access to the program does not guarantee access to health care services due to limited physician participation. According to Marshall, "I’ve said it many times: Medicaid is the most broken program in the country. Having Medicaid does not mean you have access to health care. Only 74 percent of physicians accept Medicaid, and many of those who say they do never see patients on Medicaid. Others string out appointments and limit the number they will see. Many specialists use the 'busy schedule excuse' and give Medicaid patients appointments months and months out; for all practical purposes, they exclude them from their practice."

Marshall points out that while spending on Medicaid has grown significantly over recent years, overall health outcomes have declined during that period. He states that Republican proposals aim to maintain financial stability for the program so it can continue serving vulnerable groups such as seniors in nursing homes and people with disabilities.

"Our plan will strengthen and save Medicaid for those who need it the most," Marshall says. "By keeping the program fiscally solvent, Republicans are protecting seniors in nursing homes and all those with disabilities. We are ensuring funding will remain available for pregnant moms and prioritizing funding for children. In fact, almost half of all the children in the country—37 million—are now on Medicaid’s CHIP program. We must prioritize every dollar we have for those who need it the most."

He also references public support for work requirements within Medicaid programs: "Over 60 percent of Americans support work requirements for Medicaid; a job is the best safety net out there, not to mention a great treatment for mental health and addiction issues."

Marshall suggests alternatives such as increased block grants to federally funded Community Health Centers and rural hospitals as ways to improve care delivery systems outside traditional models.

"I believe there are better solutions out there than throwing more money at a program that doesn’t work well," he writes. "More block grants to federally funded Community Health Centers, which are developing a broad-based, more holistic approach to health care—which I believe will become a big part of the 'Make America Healthy Again' movement."

He further discusses challenges facing rural hospitals tied closely with local economic conditions: "Another is block grants to rural hospitals, which are struggling. The best thing we can do for rural hospitals is strengthen our agricultural economy, which last year suffered its largest drop in net income in my lifetime." He adds that provisions related to biofuel production, taxes on farmers, and crop insurance included in GOP-led farm legislation are intended to help boost these communities.

Marshall concludes by expressing hope that economic improvements spurred by Republican policies will lead individuals currently dependent on Medicaid toward jobs with benefits: "We hope that this GOP bill spurs the economy, and expect that if anyone loses Medicaid, it’ll only be because they found a good job with benefits. A good job is the best safety net out there."