Revisiting “The Politics of Debt” One Year Later
By Mike Pierce | September 10, 2026
This week, New York Times reporter Sarah Kliff, who is probably the sharpest chronicler of our broken healthcare system right now, ran a bombshell story exposing the brutal debt collection tactics employed by Kansas Senator Roger Marshall in his capacity as an OB/GYN and co-owner of a medical practice serving rural communities across the state. Kliff’s reporting shows how the business of medicine targets vulnerable people and uses debt—and the full weight of the government—to exploit their economic precarity.
The details are grisly:
“Mr. Marshall, a Republican who is seeking re-election this fall, filed lawsuits against more than 700 patients with outstanding bills during his decades-long career as an obstetrician-gynecologist, according to a New York Times analysis of Kansas court records. Patients were arrested in 81 of those cases for missing court dates, the records show. In an additional 13 lawsuits, Mr. Marshall’s lawyers sought warrants but it is unclear whether an arrest occurred. They also garnished patients’ paychecks and bank accounts. They routinely charged patients an 18 percent annual interest rate.”
This case is extreme: a sitting U.S. Senator in a tight reelection race appears to have sought and won jail time for patients who could not afford their medical bills. It is also another clear sign that our healthcare system is fundamentally broken. Over 100 million Americans across the country—1 in 3 people—struggle with the weight of medical debt. This debt is a consequence of unaffordable healthcare. When families cannot pay a medical bill, it turns into a debt owed to a hospital, clinic, or doctor’s office. This can drive families into bankruptcy and ruin their financial lives.
In the case of Senator Marshall’s prior medical practice, the patients reportedly being targeted were women seeking healthcare, often due to a pregnancy loss or a complication during childbirth. Women ended up in debt in some of the darkest moments of their lives, only to be relentlessly targeted by debt collection lawyers working for Senator Marshall.
Senator Marshall’s debt collection tactics were his own choice. He was the sole or co-owner of his medical practice and he personally signed some of the paperwork that showed up in court.
The existence of medical debt is also his choice as a United States Senator. Our government has failed to deliver universal healthcare, knowing full well the economic consequences for families.
Over the past few years, some policymakers have attempted to deal with medical debt: executing jubilees at the state and local level, proposing rules to keep medical debts off of families’ credit reports, and restricting or banning interest charges when patients cannot pay medical bills. These are all important steps and it’s good to see so many candidates and lawmakers at every level of government take this fight head on.
When President Trump came back into office, he took the opposite approach and Senator Marshall has supported him every step of the way. Trump’s Consumer Financial Protection Bureau cut a deal with the big credit reporting agencies to roll back a rule that would have kept most medical debt off of families’ credit reports. Trump’s Department of Health and Human Services proposed letting insurance companies make loans to patients who can’t keep up with rising healthcare costs. And, of course, Trump’s One Big Beautiful Bill Act—the partisan budget bill that cut taxes for billionaires and giant corporations—made the deepest cuts to Medicaid in our nation’s history and is projected to kick millions of people off of their health insurance.
Revisiting “The Politics of Debt” One Year Later
Medical debt is just one way that debt is shaping how families experience the American economy in 2026. One year ago this week, my colleague Persis and I published our first substack at IN DEBT, arguing that debt is not just a key part of the story about how Americans experience the economy, but an untapped political opportunity for candidates looking to meet voters where they are. We made a positive pitch around the Politics of Debt, arguing that “an economic populist policy agenda on debt also makes for popular politics.”
This is the affirmative case for candidates to put debt at the center of their economic message, an approach we’ve seen play out over the past year, as an ideologically diverse slate of aspiring Democratic politicians leaned into this framing.
Michigan Senate candidate Abdul El-Sayed wants to cancel medical debt as part of his push for universal healthcare, stumping across the Wolverine State and telling the story of his successful push to deliver debt relief to patients when he was a public health official.
Ohio Senate candidate Sherrod Brown, the former chair of the Senate Banking Committee, has put the fight against data centers and energy companies at the center of his affordability agenda, pleading to cap energy bills at a moment when our research shows that more than 250,000 Ohio families owe a debt to a utility company. Florida Senate candidate Angie Nixon wants to cancel medical debt too, along with student debt at a time when a record number of Americans have fallen into default and are struggling to afford their monthly student loan bills.
Last month, Texas Senate candidate James Talarico gave a speech that laid out his broader economic vision, anchoring his pitch on affordability to Texans’ struggles with growing debts:
“Working Texans, working Texans are drowning and they’re drowning in debt. Household debt reached an all-time high in the first quarter of this year. It is time to cancel medical debt and stop hospitals and insurance companies from overcharging their patients. You shouldn’t go into debt just because you get sick.
It is time. It is time to also cap sky-high credit card interest…and reel in these predatory credit card companies that are ripping off working people across this state and across this country.
It is time to invest in college and career education like we did with the GI bill to educate an entire new generation of Americans without saddling them with a lifetime of student debt.”
Our polling has shown that government action to help Americans’ struggling with debt remains wildly popular, one of the very few cross-partisan issues remaining in our deeply polarized country. In July, we asked voters about it again.
Both the moral and political case to help families struggling with debt seems to have shaped how Kansas U.S. Senate candidate Adam Hamilton has responded to the Marshall scandal. In deep red Kansas, Hamilton is running on a platform that pledges relief for patients struggling with medical debt.
In Kansas, Hamilton is both making the affirmative case to deliver medical debt relief to Kansans if elected and the negative case that Marshall’s heinous debt collection tactics make him fundamentally unfit for office. As campaign season enters the home stretch, we expect to see more candidates leaning into the politics of debt: holding incumbents accountable for breaking promises to lower costs and demanding our government deliver for families who are forced to turn to debt just to make ends meet.
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Mike Pierce is the Executive Director of Protect Borrowers. This blog was also published on In Debt, a Protect Borrowers Substack.