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.¹ 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.

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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.²

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.

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 dom