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Health care is the top issue in Michigan's U.S. Senate race and one of the most confusing. Here's a plain-English look at what Congress has and hasn't done, what the Great Healthcare Plan and Medicare for All actually propose, and the other ideas on the table.
Table of Contents
- Where Things Stand in Congress
- What Happened to Premiums and Coverage
- What Is the Great Healthcare Plan?
- The $90 Checks and Other Executive Actions
- What Is Medicare for All?
- Other Ideas on the Table
- Questions to Ask
- Things People Get Wrong
Most of us want the same thing from health care: to see a doctor when we need one without going broke. Where we disagree is on how to get there, who pays and what role government should play.
That disagreement is playing out right now in Congress, in the White House and in Michigan's U.S. Senate race, where Democrat Abdul El-Sayed has made Medicare for All his signature issue and Republican Mike Rogers has made it his signature attack. This guide lays out the facts as of October 9, 2026, so you can judge the arguments for yourself.
Where Things Stand in Congress
The short version: almost nothing on health care is moving.
The biggest change this year happened by inaction. The enhanced Affordable Care Act (ACA) premium tax credits, which lowered what people pay for marketplace insurance and removed the income cap on who qualified, expired on December 31, 2025 after Congress did not renew them. (The original ACA subsidies are still in place; it's the pandemic-era enhancements that ended.)
In January, the House passed a three-year extension 230 to 196, with 17 Republicans joining Democrats. The Senate never voted on it. A bipartisan Senate compromise led by Susan Collins and Jeanne Shaheen, which would have extended the credits for two years with new income limits and a $5-a-month minimum premium, stalled in mid-January over abortion-funding language and has not revived.
What did pass? The February spending bill carried the first major reform of pharmacy benefit managers (the middlemen between drugmakers and insurers) in two decades, though most of it takes effect in 2028 and 2029, and it extended Medicare telehealth coverage through 2027 (National Law Review; American Action Forum).
The government is currently funded through December 11, 2026 under a bipartisan bill that passed with large majorities and contains no health care provisions. A long list of Medicare programs expires December 31, so a year-end health package after the election is widely expected. Whether it includes ACA subsidies will depend on who controls Congress after November 3.
What Happened to Premiums and Coverage
You may have heard that ACA enrollment dropped by 1 million, 3 million or even 14 million. Each number measures something different.
- Sign-ups at the end of open enrollment fell by about 1 million (5 percent). But many people who pick a plan never pay the first premium.
- Paid coverage, meaning people who actually have insurance, fell from 22.1 million to 19.2 million, a drop of about 3 million, or 13 percent. KFF, the nonpartisan health research organization, considers this the most reliable figure.
- "14 million" is a ten-year Congressional Budget Office projection that combines the subsidy expiration with the 2025 reconciliation law's Medicaid changes. It's a forecast, not a measurement of anything that has happened yet.
Behind the drop is a cost shock. The average premium that marketplace enrollees pay out of their own pocket rose 58 percent, from $113 to $178 a month, and the average deductible rose about $1,000 to $3,786, according to KFF. For 2027, insurers in all 50 states have proposed a median 15 percent increase, on top of this year's 20 percent.
Both parties read these numbers from their own premises. Democrats say 3 million people lost coverage because Congress let the credits lapse. Republicans say part of the drop reflects people who were never really paying or who were improperly enrolled, and that zero-premium plans invited broker fraud (Paragon Health Institute). The official national uninsured rate for 2025 was 7.9 percent, flat from the year before; the 2026 effects won't show up in Census data until 2027.
What Is the Great Healthcare Plan?
On January 15, 2026, the White House released a fact sheet called "The Great Healthcare Plan." It asks Congress to:
- Redirect ACA subsidy money away from insurance companies and send it directly to people, likely into health savings accounts
- Write "most-favored-nation" drug pricing into law, so U.S. drug prices match the lowest prices paid in other wealthy countries
- Require hospitals and insurers to post their prices
- End "kickbacks" to pharmacy middlemen and brokers
- Require insurers to publish denial rates and wait times
Two things are important to understand. First, it is a framework, not a bill. It names no legislation or sponsor. The one bill with a similar name, Rep. Eric Burlison's "Great American Healthcare Plan" (H.R. 8324), has 14 Republican cosponsors and no committee action. The direct-payment idea's one legislative vehicle, a bill from Senators Mike Crapo and Bill Cassidy, failed 51 to 48 in December 2025 and has not come back.
Second, the one piece that is moving is price transparency, and it's bipartisan. The Patients Deserve Price Tags Act, sponsored by Republican Roger Marshall and Democrat John Hickenlooper, cleared the Senate health committee on July 22. A House companion cleared the Energy and Commerce Committee 45 to 0 the day before. Neither has passed a full chamber yet, and both predate the plan.
Supporters of the plan argue that money should go to patients rather than insurers, and that insurers keep up to 20 percent of subsidy dollars for profit and overhead. Critics note that the Crapo-Cassidy version would have deposited $1,000 to $1,500 a year into health savings accounts, while the average bronze-plan deductible is about $7,500, so the deposits would cover a fraction of what the enhanced subsidies did (Healthcare Dive).
The $90 Checks and Other Executive Actions
With Congress stalled, the administration has used existing authority to deliver visible results before the election. None of these required a vote.
- $500 "refund" checks to about 950,000 unsubsidized HealthCare.gov enrollees in 30 states, including Michigan, began mailing September 30. The administration frames them as returning user-fee overcharges (ABC News).
- $90 one-time payments to more than 20 million Medicare Part B enrollees, announced October 2 and drawn from a fund Congress created in 2008. The Part B premium is about $203 a month, so $90 covers a bit under half of one month. Democrats called the timing a bribe; the White House says it's returning money to seniors (CBS News).
- A price transparency rule finalized October 5 requires insurers to publish their negotiated rates in standardized files and have their CEOs attest to accuracy (HHS).
- Medicaid work requirements from the 2025 reconciliation law are being implemented by rule, with states required to verify 80 hours a month of work, school or community service for able-bodied adults by January 1, 2027.
What Is Medicare for All?
The Medicare for All Act of 2025 (H.R. 3069 / S. 1506) was introduced by Sen. Bernie Sanders and Rep. Pramila Jayapal, with Michigan's Rep. Debbie Dingell as a lead House sponsor. According to the bill text, it would:
- Cover every U.S. resident for hospital, primary, mental health, prescription, dental, vision, hearing, reproductive and long-term care
- Charge no premiums, deductibles or copays, with no networks or prior authorization
- Phase in over about two years
- Fold Medicare, Medicaid, CHIP and federal employee coverage into one program
- Make it unlawful for private insurers to sell, or employers to offer, coverage that duplicates the program's benefits. Supplemental coverage for things the program doesn't cover would still be allowed, but because the benefit list is so broad, that market would be small.
- Pay hospitals through negotiated annual budgets and doctors through a national fee schedule
- Fund it through redirected federal health spending plus new taxes, whose rates the bill does not specify
It has roughly 114 House and 16 to 17 Senate cosponsors, meaning fewer than half of Senate Democrats have signed on.
Is It Socialized Medicine?
Not in the precise sense, though the label gets applied loosely. The distinction matters:
- Socialized medicine means the government both pays for care and owns the hospitals and employs the doctors. The United Kingdom's National Health Service is the textbook example. The closest American version is the Veterans Health Administration.
- Single-payer means one entity, usually the government, pays everyone's medical bills and sets prices, while hospitals and doctors remain private businesses. Canada works this way. So does today's U.S. Medicare for people 65 and over.
- Regulated multi-payer means everyone must buy insurance from heavily regulated, mostly nonprofit private insurers, with subsidies for those who need them. Germany, the Netherlands and Switzerland reach universal coverage this way, with no single payer at all. Structurally, this is closer to the ACA than to Medicare for All.
Medicare for All is the second thing. Hospitals and doctors stay private; the government becomes the insurer, as it already is for about 68 million Medicare enrollees (KFF Health News). El-Sayed himself calls it "socialized insurance" in his 2021 book.
A skeptic's fair response is that the label matters less than the mechanics, and the mechanics are sweeping. "It's a government takeover of hospitals" is inaccurate. "It would end private insurance as most people know it" is accurate. More than 150 million Americans, about 53 percent, have employer coverage they would be moved out of.
Medicare for All in Michigan's Senate Race
El-Sayed, an epidemiologist and former Detroit health director, won the August 4 Democratic primary over Rep. Haley Stevens by about one point. He faces Republican Mike Rogers on November 3. The 270toWin polling average has El-Sayed ahead roughly 48 to 44, though individual polls have ranged from a seven-point El-Sayed lead to a two-point Rogers lead.
El-Sayed's 2026 framing is softer than the bill text, and that gap is the live controversy. He has described the program as working "like a second card alongside private insurance" and said he hopes employer and union plans "will be there for you" (WDET). But Section 107 of the bill bars employers from offering duplicative coverage, and in 2020 he said the plan "does away with the private insurance market." His defensible reading is that supplemental benefits would survive; his critics' defensible reading is that an employer plan as people know it would not.
On taxes, he told Meet the Press that people would pay "a little bit more" through payroll taxes in exchange for coverage they can't lose with a job. Bridge Michigan's fact check of Rogers' claim that the plan would raise taxes rated it "likely correct, though some families could end up paying less overall" once premiums and deductibles disappear.
Rogers backs a narrower agenda: drug-price action, publishing negotiated prices, penalizing insurer denials and the administration's TrumpRx program. He skipped the September 15 debate.
What Would It Cost?
You'll hear that Medicare for All "costs $32 trillion" and that it "saves money." Both can be true, because they describe different things.
The $28 to $34 trillion over ten years figures (from the Mercatus Center, the Urban Institute and the Committee for a Responsible Federal Budget) are new federal spending. Most of it replaces premiums, deductibles and state spending that households, employers and states already pay (CRFB). Urban's John Holahan told Bridge Michigan in September that a comparable plan could now cost close to double the 2020 estimate.
The question that matters for the country is whether total national health spending goes up or down, and here the estimates straddle zero: a Lancet study found 13 percent lower, the Congressional Budget Office found roughly flat, RAND found slightly higher and Urban found substantially higher. Three assumptions explain nearly all of the difference:
- How much hospitals and doctors get paid. Private insurers currently pay hospitals about 2.5 times what Medicare pays. Studies assuming Medicare-level pay find savings; studies assuming higher pay do not.
- How much more care people use when it's free at the point of service.
- How much administrative cost disappears. The U.S. spends about $1,055 per person on health administration versus $306 in Germany, the next highest.
CBO's finding is the one both sides should sit with. Under low-payment, no-cost-sharing versions, it projected that demand would outpace supply, so waits and forgone care would increase. Supporters emphasize that total spending can stay flat while everyone is covered. Critics emphasize that waiting lists are part of how. Both are reading the same page.
For context: the U.S. spends about $14,775 per person on health care, roughly double the $7,860 average of comparable wealthy countries, and ranks last of 10 wealthy nations overall in the Commonwealth Fund's 2024 comparison, while ranking second on the quality of care people receive once they get it (Peterson-KFF; Commonwealth Fund). The top performers were Australia, the Netherlands and the UK, three different models. Every peer system beats the U.S. on cost and coverage; the evidence does not say single-payer is the best of them.
Other Ideas on the Table
Medicare for All and the Great Healthcare Plan are two ends of a spectrum. Several ideas in between have real evidence and, in some cases, bipartisan support.
A public option. A government-run plan sold alongside private ones. Three states have tried it. Washington's grew from 1 percent to 30 percent of its marketplace after the state required hospitals to participate. Colorado's reached 47 percent but missed its premium-reduction targets. Nevada's 2026 launch enrolled a third of its goal (KFF Health News). Lesson: a public option lowers premiums only when paired with provider-participation rules or rate limits.
Restoring or redesigning the ACA subsidies. Permanent restoration would cost about $335 to $350 billion over ten years per CBO and keep roughly 4 million people a year insured. Middle-ground designs include the Collins-Shaheen two-year version with a 700 percent of poverty income cap, or relief targeted just above the old 400 percent cliff.
Health savings account deposits plus catastrophic plans. The Republican alternative described above. Supporters say it puts money in patients' hands; critics say deposits of $1,000 to $1,500 don't go far against deductibles of $7,500 to $10,600.
Site-neutral payment. Paying Medicare the same rate for the same service whether it's done in a doctor's office or a hospital-owned clinic. CBO scores the broad version at $157 billion in savings over ten years. This has the widest support across the ideological spectrum; hospitals oppose it.
Hospital price caps. RAND found that capping what private insurers pay hospitals at 100 to 150 percent of Medicare rates would save $62 to $237 billion a year, far more than transparency alone (HFMA). This is the sharpest ideological divide: regulate prices directly, or rely on transparency and competition.
Reinsurance. States cover insurers' costliest claims so premiums fall. Across a dozen red and blue states, first-year premiums dropped about 17 percent on average (Avalere). It mostly helps unsubsidized buyers and costs public money.
Capping the employer tax exclusion. The tax-free status of employer health benefits is the single biggest subsidy in the system. Economists across the spectrum favor limiting it; unions and employers oppose it; no bill has moved.
Questions to Ask
When you hear a candidate or a neighbor make a health care argument, try starting with the problem instead of the party:
- What outcome do we actually want?
- Who benefits? Who pays? Who carries the risk?
- What are the tradeoffs the proposal's supporters aren't mentioning?
- What does the other side see that I might be missing?
- What evidence would tell us whether it's working?
The Medicare for All debate, for instance, is less about socialism than about three numbers nobody can pin down: what hospitals should be paid, how much more care people would use, and how much paperwork could disappear. A skeptic and a supporter can agree on the evidence and still disagree about the trade. That's a better conversation than the one about labels.
Things People Get Wrong
"Medicare for All is socialized medicine." Socialized medicine means government-owned hospitals and government-employed doctors. Medicare for All is single-payer insurance with private providers, like Medicare today. The fair counterpoint: it would end private insurance as most people know it.
"You'd keep your employer plan." Not as written. The bill bars employers from offering duplicative coverage. Only supplemental coverage for things the program leaves out would survive.
"Trump's plan passed." It's a White House fact sheet. Its direct-payment idea failed in the Senate in December 2025. Only the transparency plank is advancing, and it was bipartisan before the plan existed.
"Congress passed the $90 checks." The administration drew on a 2008 fund with broad language. Congress itself tapped the same fund in 2010 to help pay for the ACA.
"Medicare for All costs $32 trillion" vs. "it saves money." Both can be true. $32 trillion is new federal spending that mostly replaces what people already pay. Whether the country spends more or less in total depends on assumptions.
"Every other rich country has single-payer." Germany, the Netherlands and Switzerland cover everyone through regulated private insurance. Canada's single-payer covers far less than the U.S. bill would (no drugs, dental or long-term care for most people).
"The uninsured rate has already spiked." Official 2025 data show 7.9 percent, flat. The 2026 increase is expected and visible in marketplace data, but won't appear in official uninsured figures until 2027.
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