• In Michigan’s Senate Democratic primary, El-Sayed brings Medicare for All back into the spotlight, while rivals seek ‘public option’
• Health care affordability continues to be a dominant issue for voters as premium costs rise and big federal changes loom 
• Health system overhauls remain a tough political sell, but experts say stances on the issue may help Dems differentiate themselves

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Eight years after he pledged to bring Medicare for All to Michigan as part of his unsuccessful bid for governor, Abdul El-Sayed says he’ll fight to bring universal health care to the whole country if elected to the US Senate.

Health care costs and access have emerged as key issues in the Democratic primary for Michigan’s open US Senate seat, where El-Sayed stands alone in his push to enroll all Americans in what critics call an expensive government-run system Congress is unlikely to ever adopt. 

“A lot of people want to tell you what you cannot have and should not fight for — I’m just not one of them,” the former Wayne County health official said in a recent forum hosted by Statewide Indivisible Michigan.

“I believe, as a doctor who understands the system, who’s worked in the system, that we can do this.”

The push for a single-payer health care system has become a calling card for the nation’s most progressive candidates, and one popularized in a failed 2016 presidential campaign by US Sen. Bernie Sanders, who has backed El-Sayed and will campaign with him in Michigan next month. 

Related:

• Bridge Listens: Health care costs climbing, challenges loom. What to know
• Bridge Listens: How Michigan’s next governor would address fix health care
• Senate hopeful Mike Rogers floats copays, high-risk pools for health care

But in the race to replace retiring US Sen. Gary Peters, other major Democratic candidates instead want to give Americans a “public option” for insurance coverage. They contend it’s a more politically feasible approach, although one Peters has unsuccessfully advocated for since co-sponsoring legislation in 2019. 

Creating a government-run plan to compete with private insurers — rather than replace them — would be the quickest way to lower overall costs and “ensure that everybody has access to health care without going bankrupt,” state Sen. Mallory McMorrow argued in the Indivisible forum. 

That’s largely the same position as US Rep. Haley Stevens, who also supports creating a public option but has not introduced legislation in Congress to do so. During her 2018 congressional bid, she briefly supported Medicare for All, but walked back that endorsement before she was elected.

Republican Mike Rogers, meanwhile, has floated the idea of rolling back some provisions of the Affordable Care Act, otherwise known as Obamacare, and is expected to release a full health care plan soon. 

A pressing issue

About 1 in 5 Bridge Michigan readers identified health care as one of the state’s most pressing election-year issues, according to Bridge Listens, our nonscientific survey. Weigh in now. 

Since Congress adopted the Affordable Care Act in 2010, lawmakers have considered several changes or full overhauls. Lately, the discourse has been dominated by rising insurance premiums, high prescription drug costs and federal spending cuts expected to impact Medicaid and rural hospitals.

Costs of insurance, long-term care, prescription drugs and other health care needs “continue to be major issues for voters of all ages, and so they’ll be looking to candidates in the 2026 election to address those concerns in their platforms,” John Z. Ayanian, director of the U-M Institute for Healthcare Policy and Innovation, told Bridge Michigan. 

Among Democrats, that conversation has largely centered around how to expand coverage, whether that’s building off of the Affordable Care Act, overhauling the system entirely or something in between. 

But even if Democrats sweep the midterms, they’ll still need to work with President Donald Trump for the next two years, meaning they are unlikely to make immediate reforms or undo recent spending cuts. 

Advocates for universal health care already have eyes on 2028, and say their current priority is “damage control” with an eye towards winding back the biggest effects of Medicaid cuts and expired health care subsidies.

“If people are expecting massive change after this election, specifically about health care, it’s going to be challenging right now,” said Rob Davidson, a West Michigan emergency physician and executive director of the Committee to Protect Health Care.

Still, Davidson said there’s a role for nuanced debate this election cycle on what expanding health care while lowering overall costs could look like. He just hopes that candidates and voters can see the forest for the trees. 

“I think we do a disservice, both to the Democrats running, but also to voters, to pin people on a particular way to get to universal health care,” he said, later adding: “We have to be open to all of it.” 

Medicare for All 

A medical doctor by training, El-Sayed has made guaranteed health care coverage through Medicare for All a core part of his campaign for Senate. 

Eight years after proposing a similar plan for Michigan and writing a book about it, El-Sayed told Bridge he is frustrated health care costs have continued to climb but “grateful that we are in a position to be able to speak to the pain that Michiganders are facing with the real solutions.” 

While the Medicare for All legislation Sanders has championed would eliminate private insurance options, El-Sayed said earlier this year he supports allowing an option for workers to keep supplemental private insurance provided by unions or employers. 

That shift sparked criticism from McMorrow, who said earlier challenged El-Sayed to be “honest about what you’re fighting for — not rewriting definitions to have it both ways.”

Single-payer health care proposals have been a perennial priority for progressives, but they’ve never garnered majority support among congressional lawmakers or voters, many of whom value the choices private insurance offers despite any problems they encounter, said Ayanian, the U-M expert. 

Some voters are also wary of putting the government fully in control of their health care and fear such a system could limit their choice or create longer waiting times for procedures or new treatments, he said. 

“It’s an uphill battle for advocates of single-payer systems to convince most Americans to give up what they currently have with the private insurance system and put their faith in a government-run system,” he said. 

Any version of a single-payer system would also come with a high price tag. 

John Holahan, a fellow with the Urban Institute, estimated in 2020 that the Sanders Medicare for All plan would cost $34 trillion in federal spending over 10 years, including the existing costs the federal government currently spends on health care. Accounting for inflation and other factors, he told CNN and later confirmed to Bridge that he projected a single-payer plan would cost nearly twice as much as that initial estimate in 2026. 

Advocates for Medicare for All contend that US residents already pay far more for health care than other nations without the same level of benefits. 

And they argue Medicare for All could ultimately lower total costs by cutting private insurer profits, streamlining health care administration and empowering the government to negotiate lower drug prices and provider payments. 

For individuals and families, the proposal backed by Sanders would eliminate premiums, deductibles and most co-pays.

“A lot of Democrats are out here like, ‘Listen, we can’t say, guarantee health care, Medicare for All, because people are going to disagree with that,’” El-Sayed said. “Your job is not to say what is popular. Your job is to make popular what is right.” 

The public option

McMorrow and Stevens would both prefer to give Americans a “public option” — a government-run health insurance plan that would compete in the market alongside private insurers.

That direction may have broader appeal to labor groups, many of whom have been wary of Medicare for All over concerns that it could impact employer-sponsored health plans negotiated in the bargaining process.

At least three states have rolled out some form of public option for their residents, though some researchers warn that recent federal changes could blunt the impact. 

Citing outcomes in other states that have implemented a public option, McMorrow said the public option could help make the health marketplace more competitive, ensure everyone has some form of insurance and drive down private insurance costs without losing access to speedy appointments and specialized care. 

“When we talk about health care, too often we’re just talking about insurance and how we pay for it, and we’re not talking about the deliverables,” McMorrow said. “There should be nobody in Michigan who does not have health insurance, and I believe the best way to get there as quickly as possible is by implementing a nationwide public option.” 

Stevens recently told Bridge “we absolutely need to expand and protect” the Affordable Care Act, and has also supported legislation to make tax subsidies for Affordable Care Act plans permanent. Those subsidies expired last year. 

“This is something that I am hearing from Michiganders all over the state in terms of these rising health care costs, particularly our labor unions and their members,” she said. “It’s unconscionable.”

“Health care is not something I’m just talking about, it is something that I’m actively working on and, in some cases, getting results on,” she said.  

Experts say the public option could be a more middle-ground approach, but one that still faces an uphill battle in Washington, where congressional Republicans and the Trump administration have resisted the idea.

“Would a public option save money? It could, if it was done as a Medicare buy-in or Medicaid buy-in, but those involve paying hospitals and doctors less,” said Marianne Udow-Phillips, executive director of the Center for Health and Research Transformation.

Any major change to coverage options would bring trade-offs, she added.

“There’s no magic bullet out there that says, ‘Oh, it would be painless to pay 20% less on health care than we’re paying now,” she said. “It could bring down the cost…but it’s not going to make enough of a change for most consumers without some other kinds of cuts.”

Unwinding the ACA

While they disagree on how to get there, all three Democratic candidates are seeking some expansion of existing health care coverage. 

On the Republican side, Rogers, the likely nominee, was a vocal opponent of the Affordable Care Act when he served in the US House and more recently opposed extending an enhanced premium tax credit program for health insurance plans bought through HealthCare.gov.

During a March 21 event in Macomb County, Rogers told supporters he is interested in ending no-cost preventive care for health insurance plans, creating “catastrophic funds” for the sickest patients and boosting staffing at federally qualified health centers by forgiving student debt for doctors.

Undoing the Affordable Care Act’s requirement for insurers to provide certain no-cost preventive care services to patients would lower costs in the short term, but would also result in people getting fewer physicals and screenings that can catch major issues early, experts recently told Bridge.  

Speaking to reporters after filing his campaign’s petition signatures April 17, Rogers said he’d be releasing a full health care plan soon that aims to lower prices and improve health care quality. 

Of his opponents’ plans, he said government spending and involvement in health care “doesn’t work and it hasn’t worked, and this is why I think people are upset.” 

“The system we have isn’t working for people,” he said. 

Other ways to trim costs?

Though most voters’ primary health policy concern is affordability, Democrats vying for a US Senate seat have used the coverage debate as a means to differentiate themselves from one another, said Corwin Smidt, a political science professor and interim director of Michigan State University’s Institute for Public Policy and Social research. 

Citing the example of former US Sen. Debbie Stabenow — whose efforts to lower the age eligibility of Medicare to 55 and eventually 50 never gained traction in Congress — Smidt said staking a claim on health care is a way of “identifying your lane.”

“I don’t know how much of this is about policy once in Washington,” he said. “It’s trying to communicate to voters what type of candidate and what type of leader you would be.” 

Health insurance coverage is far from the only health policy issue that could shape the 2026 midterms. 

With expired subsidies pushing premiums higher, 34,000 fewer Michiganders signed up for ACA health insurance plans this year, according to federal data. Medicaid changes under President Donald Trump could lead to 300,000 fewer insured people in Michigan, according to a nonpartisan think tank analysis.

“So many people now have faced premiums that have doubled over this past year … and it’s probably going to go higher when people start getting bills,” Udow-Phillips said, calling the expiration of the tax credits and looming Medicaid changes “a big motivator for people.”

Stevens supports reversing recent Medicaid cuts, as well as further expanding programs to ensure more vulnerable families can stay covered. She’s supported efforts in Congress to lower prescription drug costs, but said there is “more to do” in that arena.

She also has repeatedly called for Department of Health and Human Services Secretary Robert F. Kennedy Jr.’s impeachment, including in a testy exchange with Kennedy during a recent congressional hearing. 

McMorrow has advocated for improving maternal health outcomes by expanding access to birth centers, requiring insurance reimbursement for midwife and doula care and implementing the state’s “Rx Kids” cash grant programs for new moms at a national level. In the Michigan Legislature, she also supported codifying provisions of the Affordable Care Act at the state level. 

Experts told Bridge there are options to lower health care costs that could win bipartisan support, including rooting out improper payments in the Medicare system, streamlining administrative costs and more broadly increasing health care transparency.

Another idea that’s attracted support from both parties is reforming facility fees collected by hospital outpatient departments, which has drawn criticism from hospitals but is something advocates say could cut costs. 

“If people don’t get serious about fixing it, it’s going to continue to be an issue for this election and the next election and the election after that, until someone finally steps up and is like, ‘Oh, we probably need to do something here,’” said Bret Jackson of the Michigan Economic Alliance.

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