Headlines throughout the country have detailed the tense political climate many U.S. Senators and Representatives have walked into at town hall meetings during the 2017 legislative session.
Roger Marshall, a first-term congressman who represents Kansas' First Congressional District, was met by a concerned, standing-room only crowd at Newman Regional Health in Emporia Saturday morning. Though the town hall meeting didn't reach the near-hostile level of some, it at times took on a markedly confrontational tone as Marshall and constituents conversed about agriculture and health care.
At one point late in the meeting, an exchange between Marshall and a female constituent from Emporia drew boos from some of those in attendance directed at the Great Bend obstetrician.
The conversation which led to the most intense part of the meeting involved Medicaid, which was expanded to cover more citizens under the Affordable Care Act — commonly referred to as Obamacare. A new replacement bill being touted by congressional Republicans, however, would take away that expansion. Marshall raised some eyebrows after comments he made during an interview with STAT — a national publication focused on finding and telling compelling stories about health, medicine and scientific discovery which is produced by Boston Globe Media — which ran in an article published on March 3.
"Just like Jesus said, 'the poor will always be with us,'" Marshall, a member of the 16-person Doctors Caucus in the U.S. House of Representatives, told STAT. "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, he told STAT: "Just, like, homeless people... I think just morally, spiritually, socially (some people) just don't want health care. The Medicaid population, which is (on) a free credit card, as a group, do probably the least preventative 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."
Saturday, Marshall said the comment had been taken "entirely out of context" and cited his work in Great Bend as the "only clinic within 60 miles that would accept Medicaid OB patients." He said he meant physicians still have an obligation to treat people, regardless of their ability to pay and that, in his experience, those on Medicaid often "use the emergency room as their primary care."
The aforementioned constituent — who voiced her opinion on a couple occasions during earlier discussion about environmental regulations in relation to agriculture — disagreed with his assessment and, eventually, walked out of the meeting during a confrontational back-and-forth.
Constituent: I work in a homeless shelter, my mom is a doctor, I am familiar with it. I just want to say that you are flat wrong when you say that if they are given access to health care they won't take up the opportunities to take preventative medical needs. They will go to the doctor for basic stuff. I see it all the time. The first thing that people want when they come to the shelter is health insurance.
Marshall: That has not been my experience.
Constituent: Well it sure is my professional experience.
Marshall: OK. How many emergency rooms have you worked?
Constituent: I've hung in them (with) my mother in internal medicine and I work in a homeless shelter.
Marshall: I help with homeless shelters, too.
Constituent: And I know you don't want to hear me any more, so guess what, I'm leaving.
Marshall: Well, good. Maybe someone else can talk.
This drew boos and angry criticism from some in the crowd, with one woman saying it sounded like something President Donald Trump would say and another telling Marshall, "You don't roll your eyes at your constituents when they ask you a question."
"We're your boss," Kelley Jud Lackey II of Emporia said. "A lot of us voted for you because we thought you were a reasonable, bipartisan gentleman. You're starting to show some different — you're becoming a political hack, Congressman, and I don't appreciate it. I don't appreciate being taken on a political ride in the last election."
It was the most heated part of a meeting which was run differently than the traditional town hall format. Rather than speaking briefly on a few key issues and opening the floor for questions and concerns, Marshall instead brought in local professionals to speak on agriculture and health care before fielding questions himself.
Newman Regional Health CEO Bob Wright discussed the difference in the way patients at critical access hospitals — a designation created by the Centers for Medicare and Medicaid Services to help give rural hospitals the same abilities to provide primary services as their larger counterparts — such as Newman are covered by Medicare. He said because of CMS regulations under the ACA, Medicare patients at CAHs have a smaller amount of their deductibles covered than those who go to Topeka for the same care.
Dr. Aaron Waters, who works in the emergency room at Newman, said 20 percent of the emergency room visits the hospital sees are psychiatric patients.
"Regulations have paralyzed what we can do," he said.
He said since the closure of the psychiatric hospital in Osawatomie, there are fewer places to send patients who need psychiatric help. When Newman has one of those patients in the hospital, they need one hospital police officer and one nurse watching that person at all times. Waters said in the last six months, that has cost the hospital $500,000.
"The regulations under Obamacare are overwhelming," he said.
He later said he felt the best solution was to "get government out of health care."
One of his colleagues, Dr. Matthew Turner, who is one of two general surgeons in Emporia, later responded to that belief.
"I would respectfully disagree with his assertion we should get federal government out of health care," Turner said. "I think that the regulations that the government makes, sometimes we complain about them when we're at work because they seem silly. Some of them sometimes seem silly or over-burdensome, but as has been expressed here in regard to the environment, as well in health care they're there to protect people."
He later said he was confused as to how the idea of "taking away their health insurance" in regard to Medicaid patients is going to help at all. He added he has worries about repealing the ACA, particularly as it relates to Medicaid.
"What I want to do with Medicaid is make sure we prioritize installments," Marshall said. "I think the priority should always be people with disabilities, children and the elderly. Unfortunately with Medicaid expansion, $60 billion was spent on people that, 80 percent of them are able-bodied Americans. I would much rather prioritize people that need it the most."
Tom Phillips from the Kansas Farm Bureau, who farms land in northern Lyon County along with parts of other counties, talked about regulations that have put a strain on farmers. One which he cited later in the discussion was the Waters of the United States under the Clean Water Act. He said the regulation goes as far as overseeing puddles and if it were enforced to its full extent — which he asserted is likely not possible — it would drive many farmers out of business.
"We've got some real issues in agriculture right now," he said. "Regulations, they're crazy. The EPA has gone completely crazy on some stuff. I mean, yes, we need to protect our environment, but I think the biggest thing that I like to tell people is that farmers are boots on the ground every day taking care of the environment for exactly the reason I listed. It's for the next generation. If we don't take care of what we have, we can't pass it on to the next generation."
Jacquelyne Leffler, a fourth-generation family farmer and rancher from near Americus, talked about the upcoming new version of the Farm Bill and the importance of crop insurance therein. According to Marshall, in 2015 the average income of farmers in Kansas was $6,000.
Leffler said Agriculture Risk Coverage and Price Loss Coverage are notoriously slow in reimbursing farmers for losses. Right now, she said at Bunge in Emporia soybeans are 60 cents below the board. Wheat is 80 cents below the board at MFA and corn is 55 cents below the board, she added.
"Those are direct losses that we lose automatically when we take our crops into the elevators," she said. "We need a safety net that's based on research, past experience and common sense."
Much of the conversation with constituents revolved around regulations. Lackey said his grandfather was a cattleman for many years, but his family has gotten out of the industry because lobbyists working for corporate farms, or the "big boys," is making family farms suffer and unsustainable.
He asked Marshall what he's going to do to help family farmers get a leg up "over these big behemoths" that have "more resources than any of us can dream of."
Marshall said de-regulation will help small farmers as over-regulation creates consolidation that "only the big boys can take care of."
Lackey argued that those regulations are the only things stopping them from dumping "massive amounts of chemicals" in the the environment. He asked how Marshall was going to write regulation so that it stops the "big boys from doing damaging stuff and at the same time doesn't make monkeys out of the rest of us."
Marshall re-asserted his point that de-regulation and getting rid of estate and death taxes would help small farmers. Lackey re-phrased his question, as he felt Marshall hadn't answered it in his response.
"I guess I respectfully disagree with your premise," Marshall said. "I don't think the large companies are dumping vast amounts of chemicals."
That assertion drew laughter from many in attendance. One man said he moved to Kansas from Oklahoma seven years ago when his former state was suing Arkansas for allowing runoff from chicken farms to get into their water supply.
Constituent: So saying these big companies aren't doing anything is ridiculous. It's absurd.
Marshall: I didn't say they weren't doing anything.
Many in the crowd replied, "Yes you did."
Marshall: I said it wasn't to the amount that you said it was. I can't speak to Arkansas, but I think the waters here are actually cleaner today than when I was growing up.
Lackey: And you know why? Because of regulations.
Lackey and a handful of other people in the crowd later pressed Marshall to cite regulations he felt were unnecessary or over-reaching. Marshall later stated he wasn't saying he wanted to get rid of all regulations.
"I just think they're being over-interpreted and it makes it especially hard for small producers," he said.