In the final debate of Michigan’s critical US Senate race late Wednesday, Democratic nominee Abdul El-Sayed targeted his Republican opponent’s record of voting against healthcare expansion and promoted his own vision of a country in which everyone receives coverage as a right.

Asked whether he would work to “expand, modify, or roll back policies of the Affordable Care Act,” El-Sayed reiterated his support for Medicare for All, which he characterized as “building on the incredible success” of the 2010 law. The Democratic candidate pointed out that former US Rep. Mike Rogers (R-Mich.) voted against the ACA and repeatedly opposed earlier efforts to expand health coverage for children in low-income families.

“He’s in bed with Big Insurance,” El-Sayed, the former executive director of Detroit’s health department, said of Rogers. “Nobody knows more about taking away your health insurance than he does.”

Rogers said the ACA “needs reform”—without spelling out what that would entail—and attacked El-Sayed’s support for Medicare for All, which the Republican falsely said would “destroy Medicare for seniors.” A study published in August by experts at Yale University found that a single-payer system like the one proposed in Sen. Bernie Sanders’ (I-Vt.) Medicare for All Act would save around 68,000 lives and $650 billion per year compared to the status quo.

Survey data released last week by Progress Michigan and Public Policy Polling shows that the cost of insurance is the top healthcare-related issue for Michigan voters heading into the midterm elections, as ACA marketplace premiums surge as a result of congressional Republicans’ decision not to extend enhanced subsidies.

Families in Michigan and across the country are also losing care in large numbers due to unprecedented Medicaid cuts included in the GOP’s 2025 budget law. Rogers celebrated that law as “a monumental victory for working families.”

“Michiganders are taking note and are getting fed up with the mess that Republicans created,” said Justin Mendoza, executive director of Progress Michigan. “This is further proof that we need a single-payer universal healthcare system, where insurance costs don’t constantly increase and leave families struggling. In the short term, lawmakers must act to help Michigan families afford the healthcare they need.”

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