Sen. Roger Marshall, the Kansas Republican who helped lead House Republicans' 2017 push to repeal the Affordable Care Act, spent decades building his medical career and personal wealth in part by suing patients who could not afford to pay their bills, according to new reporting.
A New York Times analysis of Kansas court records found Marshall, before entering politics, practiced as an obstetrician-gynecologist and co-founded a Great Bend surgical center that grew into a full-service hospital generating tens of millions of dollars in annual revenue.
Marshall drew salaries from both his private practice and the hospital, reporting combined earnings of roughly $780,000 in 2015 alone, according to his congressional financial disclosures. His net worth is now estimated between $3 million and $9.8 million.
The Times found Marshall and his practice filed lawsuits against more than 700 patients with unpaid bills, some as small as $101, that resulted in at least 81 arrests for missed court appearances. Patients' wages and bank accounts were garnished, and Marshall's firm charged an 18 percent annual interest rate on outstanding balances.
The lawsuits didn't stop once Marshall reached Washington, the newspaper found. Court and financial disclosure records show the hospital he retained an ownership stake in filed more than a dozen additional lawsuits against patients after Marshall was sworn into Congress in January 2017, continuing until he sold his stake that March.
That means a sitting member of the U.S. House held a financial interest in litigation against patients even as he began shaping national health policy.
Marshall parlayed his medical background into a leading voice on the House's effort to dismantle the Affordable Care Act that year, at one point remarking that he "may be the only physician in Congress to help run a hospital."
His campaign has also long emphasized his work treating low-income and Medicaid patients in rural Kansas, branding him "Doc Marshall."
Experts told the Times that the scale and severity of Marshall's collection practices stand apart from typical medical billing disputes.
Neale Mahoney, a Stanford economist who has studied hospital litigation, said research shows lawsuits follow only about 1.7 percent of hospital stays nationally, calling Marshall's record "an extreme case." Barak Richman, who co-directs George Washington University's health law program, said wage garnishments and arrests over medical debt are "definitely on the extreme side" compared with how most providers handle unpaid bills.
Payton Fuller, a spokeswoman for Marshall, disputed that characterization, saying the senator "spent decades caring for patients regardless of their ability to pay" and that arrest warrants are issued by judges, not doctors.
She said the hospital "provided millions in uncompensated care" and used billing and collection practices no different from other Kansas providers.
“Sixty days before an election, The New York Times has decided that a rural doctor keeping the hospital’s lights on is some kind of scandal. Kansans know better.”
Court records show, however, that Marshall's lawyers routinely requested the warrants themselves, filing dozens of briefs over the years arguing that arrests were necessary when patients missed court dates.
Debtors' prisons were made illegal centuries ago under federal law, but many states allow defendants to be arrested for missing court dates in lawsuits over missed payments.
Marshall stopped practicing medicine after winning his first congressional election in 2016, but some of his collection work continued through 2021.