Michigan's New Senator Brings a Detailed Medicare for All Playbook

Senator-elect Abdul El-Sayed defeated Republican Mike Rogers in Michigan's open Senate race on a night when Democrats captured both chambers of Congress — and he arrives in Washington as one of the country's most prominent advocates of Medicare for All, with a 2021 book laying out exactly how he'd build it.

Near the end of his victory speech in Detroit early Wednesday, El-Sayed returned to the line that carried his campaign: "It shouldn't be this hard to see a doctor in the richest, most powerful country in the world."

The numbers behind his win matter. In the NBC News Exit Poll, which surveyed more than 79,000 voters, 85% said they were very or somewhat concerned about healthcare costs, and 61% said the federal government should play a bigger role in helping Americans get coverage. Healthcare costs cut across party lines on Election Day.

Who stands to lose?

El-Sayed's single-payer vision would replace much of the private insurance business that sustains some of America's largest companies. UnitedHealth Group sits at No. 3 on the 2026 Fortune 500 and is the biggest healthcare company on the list. CVS Health, which owns Aetna, ranks No. 6; Elevance Health ranks No. 18.

El-Sayed has targeted the industry before. In 2022 written testimony to the Senate Budget Committee, he noted that UnitedHealth's second-quarter profit in 2020 nearly doubled from a year earlier.

What would his Medicare for All cover?

El-Sayed, 42, holds a medical degree and a doctorate, ran Detroit's health department from 2015 to 2017, and later directed Wayne County's Department of Health, Human and Veterans Services. With co-author Micah Johnson, he laid out the vision in the 2021 book Medicare for All: A Citizen's Guide.

The book describes the program as "an enhanced version of the traditional Medicare program that tens of millions of seniors rely on today" — one that would insure every American for life. A "core tenet" is comprehensive coverage:

• physician visits, prescription drugs, and emergency services
• potentially long-term care, vision, and dental
• any participating provider, eliminating out-of-network charges

He pitches it as more durable than employer coverage. "Turn 26, get a job, lose a job, get married, get divorced: none of these would cost you your health insurance under Medicare for All," he wrote in his Senate testimony.

One position has shifted. In a 2020 podcast, El-Sayed said Medicare for All "does away with the private insurance market," Bridge Michigan reported. During this campaign, he said his version would not ban private plans offered through unions or employers — though his campaign website says Medicare for All "should make those choices redundant and unnecessary."

Governance? At a July roundtable hosted by More Perfect Union, El-Sayed said the system should sit "under, but separate from, the executive branch," similar to the Federal Reserve, so it couldn't "change on a dime" with each new president. Medicare would negotiate prescription drug prices as the buyer for the entire country.

How would he pay for it?

El-Sayed and Johnson argue Americans already fund the system through taxes, premiums, deductibles, and copayments; the money would just flow through the public sector. Their financing plan has two parts:

1. Consolidate "existing federal spending on Medicare, Medicaid, and private insurance subsidies into a single stream." They also float state-level administration, freeing up state Medicaid dollars.
2. Progressive taxation: a "wealth tax on the richest Americans," a new corporate tax code, and higher taxes on investment income, plus savings from lower administrative costs and single-payer drug price negotiations.

The middle-class question is unresolved. El-Sayed said he would "hope" to avoid raising taxes on families earning around $100,000 a year, per Bridge Michigan. Experts told the outlet middle-class tax increases would likely be necessary, though some households could come out ahead overall.

Why it still faces long odds in Congress

El-Sayed has been blunt about the obstacle. "The biggest challenge is not making the math work. The biggest challenge is not architecting the system. The biggest challenge is creating the political will to get there," he told the More Perfect Union panel.

Public opinion is moving his way: an Axios-Ipsos poll released in October found 43% of Americans supporting Medicare for All, 24% opposed, and 32% unsure. But critics — from pharmaceutical companies to the American Hospital Association — argue it would eliminate healthcare administration jobs and hit middle-class families with higher taxes. A 2018 analysis by Charles Blahous, a former public trustee for Medicare and Social Security, estimated Bernie Sanders' Medicare for All bill would add $32.6 trillion in federal spending over 10 years — a figure Blahous has described as a lower bound.

Then there's the math in the Senate chamber. Democrats control both chambers in January, but Republicans and many moderate Democrats oppose single-payer. Retiring Kentucky Sen. Mitch McConnell called it an "untested government takeover" in 2019. Any bill would likely need 60 votes to break a filibuster, plus President Trump's signature.

El-Sayed won't be alone. In Maine, Democrat Troy Jackson unseated Republican Sen. Susan Collins after campaigning on Medicare for All and told the American Prospect he'd be a "dog with a bone" on the issue. The next test is whether the new progressive senators rally behind a single bill — and whether El-Sayed's room for private plans becomes a compromise or a fault line.

"Winning a single U.S. Senate seat was never the goal," El-Sayed told supporters early Wednesday. "The goal is to use that seat to transform our politics."

By Grace Kim