Representative Roger Marshall takes the oath of office with famed non–Social Darwinist Paul Ryan. Photo: Zach Gibson/AP

Representative Roger Marshall is a Kansas Republican, a former obstetrician, and a first-year member of Congress, and opponent of the Affordable Care Act. In an interview with Stat, Marshall draws upon his medical experience to explain why the law’s expansion of Medicaid is a bad thing. It is quite an interesting explanation:

“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 …



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.”

There are a few points to make here:

1. Measuring the impact of any medical treatment is usually hard. But the overwhelming weight of studies suggests eligibility for Medicaid makes people physically, mentally, and financially better off.

2. If Marshall thinks poor people need to do more preventative care, there are programs that can encourage it. Eliminating their access to regular medical care is the opposite of that. Indeed, he is complaining that Medicaid-eligible people only use health care when their arm is chopped off or they get pneumonia and visit the emergency room, and his solution is to deny them access to medical care other than the emergency room (which by law has to treat anybody who comes in).

3. Note that Marshall is not merely proposing to identify those poor people who refuse to take care of themselves and to cut off their insurance. He has decided this applies to Medicaid-eligible people as a group, and the punishment should be meted out to all of them. Medicaid doesn’t force anybody to go to the doctor, so if Marshall is sure the poor don’t want health care, he can let them stay on the program, and then only the poor people who do want health care will use it to visit the doctor. Taking away people’s right to choose something on the grounds that they don’t want it anyway is a proposal suffering from a basic conceptual problem.

4. While I am not a theologian, I feel confident in asserting that Jesus’ message about the poor is not most accurately summarized as “Let them suffer, they’re animals anyway.”