- GOP US Senate candidate Mike Rogers suggests rolling back some key Affordable Care Act provisions
- He proposed ending no-cost preventive care and recreating a form of high-risk insurance pools
- Health care has emerged as a key issue in the US Senate race, with Democrats focused on expanding government’s role
Republican US Senate candidate Mike Rogers recently told supporters he is interested in ending no-cost preventive care for health insurance plans and creating “catastrophic funds” for the sickest Americans.
“You know, if you go up and have to pay the doctor $50 for your annual physical, that’s probably okay, right?” Rogers told supporters at a March 21 event in Macomb County, according to a recording reviewed by Bridge Michigan.
Rogers was responding to a question from an attendee who asked him what could be done to lower health care costs. Rogers said he’d be releasing a full health care plan in the coming weeks that would “embrace the freedom of the free market” to start lowering prices.
His comments on preventive care copays and creating separate insurance pools for sick patients would undo two promises of the Affordable Care Act.
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Health care is expected to be a key issue in the US Senate race and has already sparked intense debate in the Democratic primary, where candidates are calling for various forms of expanded coverage.
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.
In his recent remarks, Rogers also proposed a way to boost staffing at federally qualified health centers, which are designed to affordably treat the poor but struggle to recruit doctors, calling them “one of those government programs that actually functions.”
“My argument is, if you work for five years at a federally qualified health care center, we’ll pay off your student debt for doctors,” Rogers said, arguing the health centers keep the poor out of more costly emergency room visits.
Rogers’ campaign did not directly respond to requests for clarification about his remarks.
“Mike Rogers is exploring ideas with voters to increase affordability of health care, whether that’s investing in rural hospitals, ensuring the wealthiest Americans cover their own copays, or improving transparency and access,” communications director Alyssa Brouille said in a statement that blamed Democrats for high health care prices.
Preventive care costs
In the event with supporters, Rogers likened free preventive care — as guaranteed by the Affordable Care Act — to “an auto insurance plan that would pay for your blinker’s light going out.” That would be a great insurance plan, but one that would cost drivers more, he explained.
“We need to start changing the way we look at health care,” Rogers said.
A major provision of the Affordable Care Act requires insurers to provide certain preventive care services, such as blood pressure, diabetes and cancer screenings — notably at no cost to the patient.
Dr. Mark Fendrick, who directs the Center for Value-Based Insurance Design at the University of Michigan, said that when physicals and screening have out-of-pocket costs, people get them less.
“Our work shows very clearly that even increasing cost sharing by a few dollars leads to decreased utilization of services,” Fendrick said.
But Fendrick also acknowledged Rogers “is exactly right” when he suggested free preventive services increase costs, though it’s something Fendrick has strongly advocated for for decades.
“In the short term, costs go down” if you charge copays for preventive care, Fendrick noted, but overall, “the health of individuals and populations get worse.”
Anand Parekh, chief policy officer at the University of Michigan School of Public Health, argued that if people skip preventive care because of costs, undiagnosed chronic diseases can spiral out of control and require expensive treatment.
“We end up paying for more costly care for things that could have been prevented, or at least treated at less expense,” said Parekh, who played a role in formulating the Affordable Care Act’s prevention initiatives.
Preventive care is considered by health-experts a “high-value” medical service, meaning it can do a lot to improve health at relatively low cost.
To curb costs, Fendrick urged policymakers to instead focus on “unnecessary care,” such as lots of lab tests and “CT scans for uncomplicated back pain.”
‘Catastrophic funds’
In his remarks, Rogers also suggested the federal government establish “catastrophic funds” to lower premiums, appearing to embrace the concept of high-risk pools while noting “the sickest part of our society ends up consuming the most” medical services.
“So we’re going to pay our premium based on what a normal life would be, not including these people who are really, really sick,” Rogers said.
He added: “We take the really sick people and put them in this fund that we all pay a little bit. The government pays, the hospital pays, Medicare would pay a little bit.”
Before the ACA, nearly three dozen states had high-risk pools for people with significant medical needs who couldn’t otherwise get insurance. The ACA essentially eliminated the need for those pools by mandating insurers cover patients with pre-existing conditions.
High-risk pools can reduce premium payments for healthier patients — that’s true, Parekh told Bridge. But it also leaves sicker, higher-risk patients whose expensive care will require “significant” subsidies, he said.
“This turns out to be expensive for consumers and government,” said Parekh, who also served as the chief medical advisor at the Washington-based Bipartisan Policy Center.
Returning to high-risk pool policies would be “just so crazy,” said Fendrick, telling Bridge the pools are among a series of ideas “that have been floated around conceptually for decades, but never had the policy or political chops behind” them.
Where Democrats stand
Rogers’ comments are marked contrast from the ongoing health care debate in the competitive Democratic US Senate primary
In that three-way race between US Rep. Haley Stevens, state Sen. Mallory McMorrow and former Wayne County Health Director Abdul-El-Sayed, the debate is not whether to restrict coverage, but how far to expand it.
McMorrow and El-Sayed have publicly feuded over each other’s stances on a policy known as Medicare for All, a proposal where all Americans would be covered under a single federal insurance program.
El-Sayed had long called for the program to be single-payer, where every person is enrolled by default, while McMorrow prefers a public option, allowing people to opt in or stick with private health insurance plans.
McMorrow has accused El-Sayed of “flip-flopping” on his stance by saying he’d support supplementary private coverage, while El-Sayed asserted McMorrow “copies my homework, just poorly” on issues like health care by taking a more moderate stance.
Stevens, meanwhile, has called for expanding the ACA as it exists now, without providing more detail. She had previously called for Medicare for All.
Reporter Robin Erb contributed
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