Sen. Roger Marshall's practice sued 700 patients over unpaid bills; patients trust their own doctor over Washington; two bills target primary care pay and AI denials — Morning Medical Update Weekly Recap

Sen. Roger Marshall's obstetrics practice sued more than 700 patients

Kansas court records show 18% annual interest, garnished bank accounts and arrests over balances as small as $101.

Sen. Roger Marshall, M.D. (R-Kansas), and the obstetrics practice he owned filed debt-collection lawsuits against more than 700 former patients over roughly two decades, according to a New York Times analysis of Kansas court records published Sept. 8.

Sarah Kliff reviewed thousands of pages of records and interviewed eight people Marshall sued between 2003 and 2015. The contracts patients signed carried an 18% annual interest rate, the balances ran from $101 to several thousand dollars, and the practice's lawyers garnished paychecks and bank accounts. Patients were arrested in 81 of those cases for missing court dates, over debts ranging from $114 to $4,683.

Most of the suits were filed in Barton County, a rural area with above-average poverty and uninsured rates, in a state that has not expanded Medicaid. Marshall stopped practicing after winning a House seat in 2016, collection work on some accounts continued while he served in the House, and he is on the ballot again in November.

Payton Fuller, a spokesperson for Marshall's campaign, said in a statement that "judges issue warrants when people repeatedly miss court dates, not doctors," and that Marshall treated every patient who came through the door regardless of ability to pay. Court records cited by the Times show his lawyers filed dozens of briefs requesting warrants, arguing that defendants had refused to obey court orders.

Steven Johnson, an attorney who often represented Marshall in the collection cases, defended the warrants as necessary to ensure debtors attended court dates, and said Marshall was not involved in decisions about warrants, arrests or garnishments but did set the 18% rate. Marshall's office did not answer a question about who set it.

Neale Mahoney, a Stanford University economist, said his research in one state found roughly 1.7% of hospital stays ended in litigation against the patient, and told the Times this appears to be an extreme case. Marshall introduced the Patients Deserve Price Tags Act with Sen. John Hickenlooper (D-Colorado) in July 2025, legislation that would bar hospitals that do not publicly post their prices from suing patients. It advanced out of the Senate Health, Education, Labor and Pensions Committee in July.

Related content: Sen. Roger Marshall's obstetrics practice sued more than 700 patients over unpaid bills

Patients trust their own doctor far more than anyone in Washington

Annenberg puts physicians at 87%, Anthony Fauci at 50% and HHS Secretary Robert F. Kennedy Jr. at 38%.

Half of U.S. adults say they are somewhat or very confident that Anthony Fauci, M.D., provided the public with trustworthy information about public health, down from 55% in April, according to survey data the Annenberg Public Policy Center (APPC) at the University of Pennsylvania released Sept. 9. The 5-point decline is statistically significant, and August is the first wave since October 2023 in which the share not confident in Fauci matched the share confident, at 50% each.

Confidence in Health and Human Services Secretary Robert F. Kennedy Jr. sat at 38%, statistically unchanged from 37% in April, with 40% saying they are not at all confident in him.

Both figures come from the same survey, fielded by SSRS Aug. 4-17 among 1,904 U.S. adults, with a margin of sampling error of plus or minus 3.2 percentage points.

The field period opened six days after Fauci invoked his Fifth Amendment protection against self-incrimination more than 100 times before the Senate Homeland Security and Governmental Affairs Committee, and it covered the panel's Aug. 6 party-line vote to hold him in contempt of Congress. APPC released the rest of the survey Aug. 31: 87% said they are confident their own doctor, nurse or other primary care clinician gives them trustworthy information about public health, statistically unchanged from 88% in September 2024, while confidence in the CDC, FDA and NIH has fallen to between 59% and 61% from between 72% and 74% two years ago.

That leaves 37 percentage points between how Americans rate their own clinician and how they rate Fauci, 49 points between their clinician and Kennedy, and a 26- to 28-point clinician-agency gap that has doubled since 2024.

It arrives as the exam-room conversation gets harder: 65% of physicians reported a moderate or major impact from misinformation on their ability to provide quality care this year, up from 57% in 2025, in The Physicians Foundation's survey of 1,002 U.S. physicians fielded in March. Sarah Nosal, M.D., president of the American Academy of Family Physicians, told Medical Economics that patients arrive having heard things that do not line up, and that hearing it from a physician they know and trust is how her patients make their vaccine choices.

Related content: The trust gap between physicians and federal health agencies has doubled since 2024 and Medical misinformation is eroding quality of care, trust between physicians and patients

Two bills would change how primary care gets paid and who can deny a claim

The Pay PCPs Act would send $10 billion to primary care, and the Doctors Not AI Act would bar insurers from letting artificial intelligence issue denials.

Sen. Sheldon Whitehouse (D-Rhode Island) and Sen. Bill Cassidy, M.D. (R-Louisiana) announced the Pay PCPs Act of 2026 on Sept. 9. Whitehouse introduced the bill, S. 5269, on Aug. 5; it was read twice and referred to the Senate Committee on Finance, where Cassidy is the only cosponsor.

It would appropriate $10 billion for fiscal years 2027 through 2031 to pay primary care physicians a prospective, per-member-per-month rate on top of their fee-for-service claims, representing between 40% and 70% of expected annual total allowed charges under the Medicare physician fee schedule. An earlier version, S. 4338, was introduced in May 2024 alongside a request for information the senators used to collect industry feedback.

Care management, behavioral health integration and office-based evaluation and management visits, regardless of modality, could be paid through the monthly rate, as could work that generates no claim today: emails, phone calls and patient portal messages.

The bill's findings hold that 25% or more of primary care activities go unrecognized for payment under most fee schedules. Screenings, annual wellness visits and vaccinations would stay on fee-for-service. Physicians who take hybrid payments would be excluded from the Merit-based Incentive Payment System, and Part B cost sharing could be cut by 50% for primary care services paid this way. The $10 billion would be exempt from budget neutrality. The bill authorizes all of this rather than requiring it, and a rule of construction states that nothing in it requires a primary care physician to receive hybrid payments at all.

The Doctors Not AI Act of 2026, H.R. 10210, was introduced Sept. 1 by Rep. Greg Landsman (D-Ohio) with Rep. Earl L. "Buddy" Carter (R-Georgia), Rep. Kim Schrier, M.D. (D-Washington) and Rep. Tom Barrett (R-Michigan).

It would require that any adverse benefit determination involving clinical judgment, initial or on internal appeal, be made by a licensed health care professional with training and experience in the item or service at issue, who conducts an independent evaluation of the enrollee's circumstances rather than treating an artificial intelligence output as presumptively valid.

Where an AI system was used, the denial notice would have to say so, describe its role and name the professional who made the determination along with their license and credentials. The bill would also treat AI use in utilization review as a treatment limitation under federal mental health and substance use disorder parity law. Because it amends the Public Health Service Act, the Employee Retirement Income Security Act of 1974 and the Internal Revenue Code, it reaches group and individual market coverage rather than Medicare or Medicaid.

Related content: Bipartisan Senate bill would send $10 billion to primary care and rework how Medicare values physician work