Poor ‘don’t want health care,’ Kansas congressman says, and the backlash begins

March 08--U.S. Rep. Roger Marshall said Wednesday that comments he made about the poor not wanting health care have been misinterpreted and he pointed to his record as a physician in the face of a national backlash over his comments.

Marshall, a Great Bend obstetrician, was elected to the U.S. House last year after ousting former U.S. Rep. Tim Huelskamp in the Republican primary for Kansas' 1st congressional district, which covers the western half of the state.

The health care website Stat highlighted Marshall's role in Republican efforts to repeal the Affordable Care Act in a profile published last week. Marshall's comments about the poor in that article have gained national attenntion.

"Just like Jesus said, 'The poor will always be with us.' ... There is a group of people that just don't want health care and aren't going to take care of themselves," Marshall is quoted as saying when asked about Medicaid expansion, something which was made possible by the ACA.

"Just, like, homeless people. ... I think just morally, spiritually, socially, (some people) just don't want health care," Marshall continued. "The Medicaid population, which is (on) a free credit card, as a group, do probably the least preventive medicine and taking care of themselves and eating healthy and exercising.

"And I'm not judging, I'm just saying socially that's where they are. So there's a group of people that even with unlimited access to health care are only going to use the emergency room when their arm is chopped off or when their pneumonia is so bad they get brought (into) the ER."

Marshall's interview has begun to receive national attention, with MSNBC's Joe Scarborough reading the quote on Wednesday morning's episode of "Morning Joe" before his co-host Mika Brzezinski cut him off, saying, "Oh my -- just stop!"

Scarborough said on the show that he was "absolutely floored" by Marshall's comments.

"For somebody to talk about Jesus and the poor that way is a complete twisting of everything that the Gospel is about. Everything! Read the Gospel. Read the Sermon on the Mount. ... I mean, Jesus was pretty clear," Scarborough said.

Marshall said in a statement Wednesday that he regrets "trying to address several issues with a singular response" and that he was trying to explain "we cannot build a national healthcare policy around any one segment of the population." He said that each segment of society has different health care needs and blamed the Affordable Care Act for increasing health insurance premiums for middle class families.

"When I said 'The poor will always be with us,' it was actually in the context of supporting the obligation we have to always take care of people, but we cannot completely craft a larger, affordable healthcare policy around a comparatively small segment of the population who will get care no matter what," Marshall said.

"I have worked in, and oversaw free family planning clinics for 30 years -- my office provided care for all patients regardless of their ability to pay. Many patients drove over a hundred miles to see us as I was the only OB clinic to accept Medicaid, and others who could not afford prenatal care. My career gives testimony to my personal watchfulness to those who need help, and to allude otherwise is simply not judicious," Marshall said. "I'm a physician, not a politician. While I don't perfectly rehearse talking points, my agenda is driven by two realities: That Obamacare has been detrimental to patients and that we must care for all in need, no matter what."

Kansas Medicaid advocates say Marshall's original comments display a misunderstanding of the program, which provides medical coverage for low-income families and disabled Kansans.

"The folks that are on Medicaid, they're people with significant disabilities, children and pregnant women and older Kansans who all want health care, and the state has a basic consensus that they deserve it, that they have that right," said Sean Gatewood, co-administrator of the KanCare Advocates Network, a group that represents people enrolled in the state's Medicaid program.

"I can't understand how a physician would not already have a fundamental understanding of that issue, but it doesn't feel like he does," Gatewood said.

As of this year, 19 states have not expanded their programs to provide insurance to people in the coverage gap -- people who make too much to receive Medicaid but too little to buy their insurance through the federal health care exchange. Neither Kansas nor Missouri has expanded its program.

David Jordan, the executive director of the Alliance for a Healthy Kansas, a group that wants to expand the Medicaid program in Kansas, called Marshall's comments disheartening.

Jordan said many of the people on Medicaid and in the coverage gap work multiple jobs.

"These are people who are out there, working hard, paying their bills, and to have their elected member of Congress pointing their finger at them I'm sure is disappointing," Jordan said.

He said Marshall oversimplifies the problem of health care accessibility. Some people on Medicaid, particularly in rural areas like western Kansas, have trouble finding doctors who accept Medicaid, he said.

Denise Cyzman, executive director for the Kansas Association for the Medically Underserved, said many communities in Kansas, including Great Bend, have no dentists who accept Medicaid.

Cyzman said her organization's 44 clinics throughout the state provided treatment to 77,000 Medicaid recipients in 2015 and to 262,000 people total, including people who fall in the coverage gap and who lack any insurance.

"These are people who are very interested in accessing health care," she said. "To put the onus back on the individuals saying they don't want access to health care ... is not at all representative of our experience."

Jordan said federal data show that about 97 percent of children enrolled in Medicaid saw a primary care doctor in 2012.

"To say that nobody on Medicaid benefits ... is not supported," Jordan said.

Bryan Lowry: 816-234-4077, @BryanLowry3

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