WASHINGTON — Dr. Roger Marshall was delivering babies in December. By January, he found himself across a breakfast table from Tom Price, offering emotional support to the Georgia congressman as he endured a contentious confirmation process to become the top health official in the new Trump administration.
Marshall, a few months ago just another doctor from Kansas, is now Congressman Roger Marshall.
When the longtime obstetrician first announced his candidacy in April 2015, it was far from a given that he could unseat a Republican incumbent or that his party would win the White House and complete control of Congress. But now he finds himself thrust straight into the hotter-than-ever fire of Washington health policy — and his party finds itself tantalizingly close to its dream of repealing the Affordable Care Act.
“Letting the government run anything, including health care, what happens is prices go up and competition goes down,” Marshall said in a recent interview at his office. “What we were doing was not working.”
He plans to add his on-the-ground experiences with the law to the debate in the halls of the Capitol. “I may be the only physician in Congress to help run a hospital.”
Marshall has joined the GOP Doctors Caucus, a group of 16 lawmakers with health care backgrounds who have put themselves at the center of the effort to unwind the Affordable Care Act. Two of its members have introduced legislation that would undo major elements of the ACA, and all see themselves as critical players in shaping whatever would replace it.
“Dr. Marshall is actually in a pretty important spot, whether or not he realizes it,” said Representative Phil Roe, the chairman of the caucus. “He now has a chance, an opportunity, that is only generational. This is only going to come around once in a lifetime.”
It helps to have some familiar routines. Once a week, Marshall and a group of other health care professionals gather for breakfast at a private club a few steps from the US Capitol. It’s a tradition he likens to the “grand rounds” of his medical practice — a semi-regular meeting at many hospitals in which physicians gather to review difficult cases, check in as a group, and discuss how to tackle the issues they collectively face.
But even in a comfortable setting, Marshall has been initiated in the polarized rancor consuming the nation’s capital.
As Price endured a tumultuous confirmation, he found solace in the doctors caucus, which he was a member of until he began his new job as the central figure in the Obamacare fight. It was a wake-up call for Marshall, who had never held political office.
“Certainly these last several months,” Marshall said, “seeing what Dr. Price went through, this character assassination on him, it was a good place for him to be able to sit down with us and [for us to] say, ‘How’s it going, Tom? How’s your family doing with this?’ It’s much more than just policy. I think that these are my friends and my brothers.”
For Marshall, the allegations Price faced — pushing legislation to bolster the stock of an Australian biopharmaceutical company he had recently invested in — were an eye-opening introduction to the current tone in Washington. Tensions are high as many Republicans find themselves caught between longstanding pledges to repeal and replace the Affordable Care Act and the political perils of actually following through.
Roe, also Marshall’s official mentor in the group, said Marshall’s new job may not be as straightforward as his last. Politics, in a way, is less direct than medicine.
“The frustration he will find — he has not had any public service practice before — is that as doctors, we’re used to sitting down with patients, finding out what the problem is, and fixing it,” Roe said.
Marshall is joining the group at what could prove to be the peak of its influence. He hopes to bring his medical experience — he has delivered over 5,000 babies, including a few in December just weeks before taking office — and experience as a hospital administrator to the negotiating table.
Roe, Price, and Senator Bill Cassidy of Louisiana, another Republican physician, have all introduced legislation that would undo major elements of the Affordable Care Act and reshape the American health insurance market. The first two of the caucus’s formal monthly meetings have, unsurprisingly, focused on replacement options.
They see themselves as critical players. Roe said that though it accounts for less than 4 percent of House members, his group effectively holds veto power over any Obamacare replacement provision.
“Before this bill goes through, if the Doctors Caucus came out against the alternative, I don’t think it would pass,” Roe said. After all, he argued, if the health practitioners in Congress can’t get behind a health care bill, why should anybody else?
Marshall is as quick as any Republican to slam Obamacare, claiming firsthand experience of its effects from his time at Great Bend Regional Hospital in central Kansas. He helped grow the hospital from a four-bed surgical clinic to the full-service, physician-owned facility it is today.
Like many other Republicans, Marshall said he wants the health care system to rely on the free market rather than Obamacare’s regulations. He measures success in how many people can afford to leave the Medicaid program and enter the private insurance market.
The law’s Medicaid expansion, which Kansas has not adopted despite support from many hospitals, including some of Marshall’s former colleagues, is one of the big sticking points for Republicans. Many GOP-led states adopted it and want to see it preserved in some form.
Marshall doesn’t believe it has helped, an outlook that sheds light on how this new player in Washington understands health policy.
“Just like Jesus said, ‘The poor will always be with us,’” he said. “There is a group of people that just don’t want health care and aren’t going to take care of themselves.”
Pressed on that point, Marshall shrugged.
“Just, like, homeless people. … I think just morally, spiritually, socially, [some people] just don’t want health care,” he said. “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.”
A 2013 study by the nonpartisan Kaiser Family Foundation found Medicaid’s impact on physical health inconclusive. But adults who gained access to Medicaid under the ACA showed markedly improved mental health and increased use of preventive services like mammograms and cholesterol checks, which increased by 60 and 20 percent, respectively.
The congressman describes his own practice as a first-class experience, one that he hopes to emulate nationwide. But the Affordable Care Act, he said, has made nurses and doctors at the hospital less efficient in their work and forced them to devote much of their time to data entry.
“Our vision was that we would look more like a hotel with customer service that delivered five-star health care,” he said. “So our cafeteria looks more like a coffee shop than it does a sterile hospital dining room. We have bright windows everywhere, and outside of every window there’s a garden. Thinking that healing is more than just a knife and a needle.”
As Republicans debate how to overhaul the health care system, Marshall is now in a position to add his perspective to the conversation, and he’s taking advantage of his homegrown connections.
Following discussions about high-risk pools and continuous coverage provisions, Marshall been bouncing ideas off Kansas Insurance Commissioner Ken Selzer throughout his first weeks in office, floating responses he’s gotten to questions in GOP Doctors Caucus gatherings to see if they’d work in his home state.
When Marshall first announced his candidacy in April 2015, it was far from a given that he could unseat Republican incumbent Tim Huelskamp or that his party would win the White House and complete control of Congress. But Republicans now find themselves tantalizingly close to their dream of repealing Obamacare, even if the practical and political challenges make it far from guaranteed.
Congress is in the first week of a six-week slog, its longest in-session stretch this year. If a repeal-and-replace package is ever going to move, many legislators say, now is the time.
“There are several right ways to do this,” Marshall said, “but it’s time for this ship to sail.”