(Photo illustration by Bill Kuchman/The Bulwark | Photos: Getty, Shutterstock)
Ann Arbor, Michigan
WE INTERRUPT THIS COVERAGE of Michigan’s pivotal Senate race for some breaking news: Democrat Abdul El-Sayed is not the only candidate running.
He’s got a Republican opponent, former congressman Mike Rogers. And there’s plenty about Rogers that might be of interest to voters, including his positions on health care policy.
True, health care is El-Sayed’s signature issue. The doctor and former public health official is famously an advocate of Medicare for All, the version of universal health care in which the federal government would cover everybody directly, largely displacing private insurance.
But Rogers also has some big, potentially controversial notions about how to change health care. Just for starters, he likes the idea of letting insurers charge copays for routine cancer screenings and some other forms of preventive care—which, under current law, the insurers cannot do.
That might sound like an odd position to hold when voters say they are worried about the cost of living, especially medical bills. But it comes directly from comments Rogers made to a private audience in March, via a recording later obtained by reporter Simon Schuster of Bridge Michigan.
At that meeting, Rogers got a question about what he would do to reduce the cost of health care. He promised to introduce a plan that would “embrace the freedom of the free market” and proceeded to explain that increasing out-of-pocket costs for preventive services was one way to do that.
“You know,” Rogers said, “if you go up and have to pay the doctor $50 for your annual physical, that’s probably okay, right?”
The Rogers campaign declined to respond to a series of policy questions I submitted last week, including one about that quote, so I can’t say for sure whether that’s still his position. But there’s every reason to believe that statement reflects his way of thinking—and, by the way, the thinking of many other Republicans running for office this year.
A WELL-ESTABLISHED PRINCIPLE of health care economics is that people will consume more services when those services are free. One strategy for controlling health care costs is to make you pay some kind of fee every time you use health care—say, by charging you a copay for prescription drugs.
Sometimes people in health policy refer to this approach to cost control as giving patients “skin in the game.” It’s an idea embraced by many Republicans, and some Democrats too.
But if it’s a lot of skin in the game—say, $50 for a single office visit—then chances are good people will also hold back on care they really need. They might put off a cancer screening until it’s too late, missing a tumor that might have been treatable if caught early. And if they also owe higher copays on their drugs, they might stretch the supply by cutting their blood-pressure pills in half or skipping doses, potentially increasing their risk of a heart attack or stroke.
These things can actually drive up health care costs in the long run. And that’s not to mention the fact that they can kill you.
That’s why more liberal and progressive Democrats have generally tried to minimize out-of-pocket costs, especially for essential services. That’s how the zero-cost requirement on preventive care became law. It was a key provision of the Affordable Care Act, designed to make sure that even with high-deductible policies, people had no barriers to basic, routine care.
Yes, in seeking to roll back the free preventive care requirement, Rogers is seeking to roll back part of “Obamacare.” And that’s not surprising. When it comes to health care, Rogers has the posture and positions of a traditional Republican, which means he opposes government-financed health care in general and the Affordable Care Act in particular.
That posture has direct, immediate implications for Michigan voters. Rogers’s position is an indicator of how he would vote—and, possibly, how the United States Senate would vote—on questions like whether to restore the extra Affordable Care Act subsidies that Donald Trump and Republicans in Congress allowed to lapse at the end of last year. When those subsidies went away, hundreds of thousands of Michiganders saw their premiums jump.
And it’s not just in Michigan where this is happening. Nationwide enrollment in the Affordable Care Act is already falling as a result of spiking premiums, now that Trump and the GOP have let those extra subsidies expire. The number of Americans with no insurance at all is likely to jump too, and then jump again when the Medicaid cuts Trump and Republicans enacted last year really kick in.
Pretty much every Republican running in a contested statewide race supported these moves, either with their votes (because they’ve been serving in Congress) or their rhetoric. And it helps explain why they are trying so hard to keep the conversation on Medicare for All, or on other subjects altogether.
It’s a way to distract from their own records on health care, records of opposing programs that voters value. And Rogers is as good an example as any.
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ROGERS REPRESENTED MICHIGAN in the House from 2001 until 2015. An Army veteran and respected former FBI special agent, Rogers focused in Congress primarily on issues around law enforcement, intelligence, and national security. When it came to bread-and-butter domestic policy issues, he was what qualified as a mainstream Republican back then, which meant he tended to support the business community while opposing regulations and taxes.
That was true when it came to the most important health care votes of his tenure, which were about the Affordable Care Act. He voted against the legislation as it was making its way through the House in 2009 and 2010—first, while voting on an early version while a member of the Energy and Commerce Committee, later while voting on the final legislation when it came to the floor. (In both cases, he joined every other voting Republican.) In the years that followed, Rogers voted repeatedly to repeal the law.
“MIKE ROGERS IS COMMITTED TO REPEALING OBAMACARE,” boasted a 2012 campaign mailer from the state Republican party:
The repeal votes during his tenure were in many ways symbolic—a way of registering the GOP’s intense opposition to the very idea of the law. And while Republicans always promised to “replace” the Affordable Care Act with something better, it was only after Rogers left Congress that Trump’s 2017 attempt at repeal forced Republicans to specify what they had in mind. It turned out to include dramatic cuts to Medicaid, plus blows to the private insurance reforms that guaranteed coverage—frequently with subsidies—to anybody with pre-existing conditions.
Republicans touted the plans, hyping reductions in federal spending, new tax cuts they could finance, and an end to the “individual mandate” penalty for people who didn’t get coverage. The public turned against the repeal effort anyway, spooked by the prospect of more than 20 million people losing insurance and insurers once again restricting coverage or charging substantially more to people because they had diabetes or were cancer survivors.
Again, Rogers had already left Congress by the time of those particular votes. And among my questions that his campaign declined to answer was whether he still supports repeal. But in that same recorded conversation from March, he mentioned that he would also support the creation of “high-risk pools,” which were part of the 2017 GOP bills and many proposals since.
That says a lot. The idea of high-risk pools is to create separate insurance plans for people with pre-existing conditions, rather than requiring insurers to accept them. “We take the really sick people and put them in this fund that we all pay a little bit,” Rogers said in the recording. “The government pays, the hospital pays, Medicare would pay a little bit.”
The problem is that states have tried this approach before. The plans lacked adequate funding to serve everybody who might need them, or to guarantee the level of coverage they would need. Waiting lists were common.
This is well known, and has been litigated publicly over and over again. Republicans keep proposing them—in part, undoubtedly, because it makes it sound like they are just as committed to protecting people with pre-existing conditions. Meanwhile, independent analyses keep finding that high-risk pools are not a substitute for protections that the Affordable Care Act put on the books.
THIS ALL MIGHT SEEM like ancient history, or at least irrelevant history, since at the moment nobody is talking publicly about repealing the Affordable Care Act. But Trump still refers to the law as a “disaster” from time to time. It would be fair to describe recent changes to both Medicaid and the Affordable Care Act (which go beyond not extending subsidies) as weakening critical pillars of the program.
And it’s a live issue for the next Congress. If Democrats get control of either house, or both, you can assume one of their very first acts will be approving legislation to renew the Affordable Care Act subsidies and undo most, maybe all of the Medicaid cuts. It’s one of the few causes that has universal support in the caucus already, and that prospective new members like El-Sayed have said they support too.
Trump probably wouldn’t sign either measure, but that would tee up the issue for the 2028 election—and, then, quick action in 2029 should Democrats get a trifecta. But because of the fine margins of these things, whether that happens could come down to one vote in the Senate.
Rogers indicated previously—in an email to the Michigan Advance—that he supported letting the extra subsidies lapse. He has also hailed the Republicans’ “One Big Beautiful Bill,” which is the legislation that cut Medicaid. I asked his campaign to confirm he still stands by both decisions. I didn’t get a response to that question, either.
At the moment, the only public guide to his health care agenda is a threadbare page on his campaign website that has a few perfunctory promises about seeking greater transparency in health prices, plus a statement that “there should be consequences” for insurers who deny care repeatedly.
Both are perfectly fine ideas, along with a vow he made back in the March meeting to forgive med-school debt for physicians who spend a few years practicing in clinics that serve low-income communities. None would meaningfully alter health care costs or access.
Michigan voters can interpret that silence and lack of substance as they wish. And voters elsewhere might want to think about how their own states’ Republican candidates would answer these questions. A few case studies:
In Texas, where Affordable Care Act enrollment fell by nearly 150,000 people after the extra subsidies expired, Senate nominee Ken Paxton has a lengthy record of trying to wipe out the law altogether. That includes a 2018 multi-state lawsuit he led, sending the case all the way to the Supreme Court where a 7–2 majority swatted it down.
In Iowa, Senate nominee Ashley Hinson’s record in the House includes enthusiastic support of the One Big Beautiful Bill’s Medicaid cuts, touting their new work requirements. While work requirements poll well, in practice they can hurt rural health care providers—something that may already be starting to happen, according to local health care leaders. And that’s not to mention all the Iowans who lost financial assistance with the lapsing subsidies, which Hinson also supported.
In Ohio, the projected loss of $33 billion in Medicaid funds over the next decade could force the state to reduce what it pays providers or what services it covers, or scale back eligibility for the program. One of the Republicans who voted for that bill was Jon Husted, the incumbent senator now seeking re-election.
As for Michigan, a state study found 700,000 Michiganders could lose their health care coverage from the Medicaid cuts, while Affordable Care Act enrollment this year is already down by 130,000, or more than a quarter of the total. That’s a lot of people suddenly without health insurance.
Like most Republicans, Rogers has reasons to believe these tradeoffs are worthwhile. It’s consistent with conservatives’ worldview about how policy and the economy work, a worldview they certainly defend earnestly.
But right now Rogers is not making that case. He’s not even trying. Instead, he’s dodging questions and talking about El-Sayed’s plans, evidently in the hopes voters won’t notice what Rogers himself is offering.