Raw America managing editor Carl Gibson recently sat down with Dr. Rob Davidson, an emergency room physician in rural Michigan, who is also the executive director of the Committee to Protect Healthcare and the co-host of the Paging America Substack. They covered a range of topics about the American healthcare system, including:
3 million people dropping ACA coverage after Republicans let tax credits expire
What Dr. Davidson personally witnessed treating uninsured patients in the ER
How the ACA changed his practice for the better
The threat to rural hospitals from the “big ugly bill’s” Medicaid cuts
What happens to rural communities when a local hospital closes
Healthcare as a top midterm issue and what comes next
Treating healthcare as a public good instead of a for-profit industry
Money in politics as the root obstacle to real reform, and more
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3 Million Dropped ACA Insurance Plans After Republicans Let Tax Credits Lapse
Gibson opened the conversation by citing a recent report that roughly 3 million people have dropped their Affordable Care Act (ACA) plans since Republicans in Congress allowed premium tax credits to expire, marking a 13 percent drop in enrollment.
Dr. Davidson acknowledged that the financial obstacles patients face are hard to miss, even in emergency rooms where insurance isn’t a factor. He described seeing a patient this week who likely should have been admitted to the hospital but went home instead.
“That’s a lot of money, I’m gonna go home, I’ll come back if things get worse, I’ll follow up with the doctor tomorrow,” Dr. Davidson recalled the patient saying.
Dr. Davidson said the broader pattern troubles him most: when millions lose coverage, they make healthcare decisions based on cost rather than their actual medical needs.
How the ACA Improved Healthcare in Rural America
Gibson asked Dr. Davidson, who has practiced emergency medicine since the late 1990s, to compare his practice before and after the ACA’s passage in 2010. Davidson said that before the ACA, he’d see patients repeatedly for unrelated minor injuries, only to notice things like their blood pressure climbing each visit because they had no primary care doctor and no coverage.
But after the ACA expanded Medicaid — with his state of Michigan accepting expanded Medicaid in 2014 — he says he watched some of those same patients get on blood pressure and cholesterol medication and finally get their own primary care provider. He noted Michigan was one of roughly 40 states that expanded Medicaid, benefiting nearly a million residents in the Mitten State. Nationally, ACA enrollment peaked at 23 million and has since fallen to about 19.2 million, which Davidson attributed to Republican policies.
The Human Cost of Losing Coverage
The Kaiser Family Foundation estimated that the number of insured Americans could eventually plummet to 17.5 million as ACA plans become more costly without the tax credits. Dr. Davidson pointed to two distinct dangers if that comes to pass.
The first is what happens to people who lose coverage directly: the longtime physician recalled one patient who waited five days after a heart attack to seek care because he was uninsured. By the time he finally arrived, his heart function had been reduced by half. Davidson contrasted that with patients who get treatment within the first few hours of chest pain, who can often avoid lasting damage.
The second danger, according to Davidson, is what happens when the risk pool of insured Americans shrinks. Younger, healthier people are more likely to drop their coverage and “roll the dice,” meaning those remaining are older and sicker, prompting insurers to raise premiums and deductibles. Some insurers like Cigna are already exiting ACA markets in certain regions for 2027 due to being unable to cover those communities. In Cigna’s case, that’s resulting in 369,000 fewer people with coverage.
Rural Hospitals Already Contending with Medicaid Cuts
Gibson brought up the roughly $1 trillion in Medicaid cuts Republicans’ “big ugly bill” locked in, and what that means for rural communities. Dr. Davidson noted that roughly 20 percent of hospitals in Virginia recently reported being on the brink of closure, while several hospitals in his own state are at risk of closing as well. He said he’s already seeing some hospital administrators cut back services, reduce specialist availability and rolling back lab and X-ray hours in anticipation of losing Medicaid funding once the cuts take effect — notably, not until after the midterms.
Dr. Davidson cautioned the harshest cuts are yet to come, and theorized that lawmakers who voted for the cuts may be trying to delay the political fallout as much as possible.
Gibson cited a 2025 study by the University of North Carolina’s Sheps Center for Health Services Research, referenced in a letter from several senators warning that roughly 330 rural hospitals nationwide were at risk of closure. This includes four in Dr. Davidson’s home state, and 35 in Gibson’s home state of Kentucky.
The Shock to Rural Communities When a Hospital Closes
Gibson asked what options rural residents have once their local hospital shuts its doors. Dr. Davidson pointed out that the impact isn’t limited to Medicaid patients.
“Even people with employer coverage or Medicare will be affected, because the hospitals and services disappear regardless of who’s paying,” he said.
Davidson described patients in remote areas like Michigan’s Upper Peninsula having to face multi-hour drives just to get basic screenings, as well as EMS systems being pushed to the brink by longer transport distances and rising fuel costs. He added this could lead to worse outcomes for time-sensitive emergencies like heart attacks and strokes, where every additional minute of delay means more permanent damage.
How to Fix America’s Healthcare System: Single Payer, a Public Option, or Something in Between?
When asked what he’d want to see if Democrats retake Congress and the White House in 2026 and 2028, Dr. Davidson said his Committee to Protect Healthcare is positioning itself to push for universal coverage, though he noted that single payer isn’t the only model that works. The physician pointed to Germany and France as examples of highly regulated, non-single-payer systems that regularly outperform the United States on cost, access, and outcomes.
He highlighted a proposal from the Center for Health and Democracy called Medicare by Choice, which would let individuals and employers buy into a Medicare-like public option with added vision, dental, and hearing coverage.
“Boy, that seems like a hell of a plan to me,” Dr. Davidson said, noting that a plan structured this way could potentially pass with 51 Senate votes through the budget reconciliation process rather than jhaving to clear the 60-vote filibuster threshold.
Having practiced emergency medicine in New Zealand in 2013, Dr. Davidson said universal coverage fundamentally changes the doctor-patient relationship by completely removing cost as a factor in treatment decisions. He further argued that the piecemeal, coupon-hunting nature of American healthcare delivery is a major contributor to physicians burning out and leaving the practice altogether.
Healthcare as a Public Good, Not a Profit Driver
Gibson pointed to the book “An American Sickness,” by Dr. Elizabeth Rosenthal, which examines how healthcare has become driven by what’s most profitable for business rather than what’s best for patients. He then asked Dr. Davidson directlyt whether healthcare would be better off if it were seen as a public good rather than a profit-driven industry.
“100%. It should be a public good.” Davidson said.
The Committee to Protect Heathcare executive director cited the bipartisan Break Up Big Medicine Act from Sens. Josh Hawley (R-Mo.) and Elizabeth Warren (D-Mass.), which is aimed at insurance conglomerates like UnitedHealth Group. Davidson said insurance giants have found ways to inflate profits even under the ACA’s statutory caps on overhead costs by acquiring physician groups and negotiating higher reimbursement rates. He then referenced a Chicago physician’s account of a patient who died of a treatable liver condition, saying the doctor concluded his patient hadn’t died of liver failure, but rather of being too poor to afford the necessary treatment.
The Root Obstacle: Money in Politics
Gibson asked whether money in politics or universal healthcare needs to be addressed first, given how insurance industry contributions shaped moderate Democrats’ opposition to a public option during the original ACA fight in 2010.
Dr. Davidson acknowledged campaign finance reform likely has to come first before it becomes possible to achieve significant changes to the healthcare system. He noted that Michiganders will soon vote on a ballot measure that would prevent entities with state contracts over $250,000 from contributing to campaigns. He said the initiative drew strong opposition from lobbyists in the capital city, but organizers still managed to gather more than 560,000 citizen signatures to qualify for the ballot.
The State of Abortion Rights 4 Years After the Dobbs Decision
Four years have passed since the Dobbs v. Jackson Women’s Health Organization ruling, in which the conservative Supreme Court majority overturned the landmark 1973 Roe v. Wade decision that legalized nationwide abortion rights. Dr. Davidson expressed optimism that states are taking charge to enshrine abortion rights in their own respective constitutions.
Davidson pointed to a wave of state ballot initiatives, including Michigan’s 2022 measure and 2024 votes in red states like Missouri, Montana, and Ohio, showing that abortion rights consistently win at the ballot box even among conservative voters. He pointed out that Florida’s measure fell short only because of the state’s unusual 60 percent approval threshold, despite 57 percent support from voters.
Gibson also asked about “crisis pregnancy centers” that deceptively present themselves to pregnant individuals as abortion providers, while actually working to prevent patients from abortion access. Davidson said medical organizations are pushing back, but that disinformation unfortunately extends beyond these centers.
The conversation then pivoted to the Emergency Medical Treatment and Labor Act (EMTALA), with Gibson asking Dr. Davidson how physicians navigate the tension between federal law requiring patients get life-saving treatment at emergency rooms and state abortion bans that can apply even in life-threatening cases like ectopic pregnancies.
Davidson relayed one colleague’s blunt description of the ambiguity doctors face under “life of the mother” exceptions. How much blood loss does it take before a prosecutor agrees a patient’s life was truly in danger? He recalled how one of his fellow ER physician colleagues in Wisconsin sued the state alongside another Paging America co-host to overturn a dormant 1800s-era abortion ban after Dobbs took effect.
Bill Cassidy Finding His Spine: Too Little, Too Late
Gibson brought up the sudden shift in rhetoric from outgoing Sen. Bill Cassidy (R-La.), who lost his Republican primary to a Trump-backed challenger and has since become a vocal Trump critic. Gibson asked Dr. Davidson if Cassidy’s new combative approach to the Trump administration makes up for him casting the deciding vote to confirm Robert F. Kennedy Jr. as Health and Human Services Secretary last year. Davidson was blunt.
“Too late, buddy,” Davidson said.
The longtime ER physician heaped criticism on Cassidy — who is also a physician — and argued that a politician who abandoned his medical oath for political convenience shouldn’t get credit for speaking up only after he had nothing left to lose.
Did Vaccine Skepticism Kill a Military Recruit? And Are We Equipped for Another Pandemic?
Gibson also asked about how the Trump administration’s warmth toward vaccine skepticism is taking a human toll. Recently, the U.S. Air Force confirmed that 25-year-old Keon McDaniel died from a flu outbreak at Joint Base San Antonio-Lackland, which spread after Defense Secretary Pete Hegseth lifted vaccine requirements for troops. The requirement was later reinstated after the outbreak affected close to 300 people at the base.
Davidson called the tight conditions in military barracks a “petri dish” for infectious disease and said the data makes clear that the flu shot reduces transmission rates and saves lives.
When asked about the prospect of another pandemic given current federal health leadership, Davidson noted the incompetent response of the first Trump administration’s handling of the Covid-19 pandemic. He added that messaging from the top, including suggestions about ingesting bleach and opposition to masking, embedded itself in public behavior throughout the pandemic. He further expressed concern that state health departments and figures like RFK Jr., Dr. Oz and Jay Bhattacharya now dominate federal public health institutions.
Is it Too Late to Rebuild Trust in Government Institutions?
Gibson asked whether the credibility of agencies like the CDC can ever be restored after four years of leadership by officials who lack credibility and eschew expertise. Davidson said it’s possible but acknowledged it will likely take a generation.
He argued that after the midterms, Democrats controlling either chamber of Congress need to hold RFK JR’s HHS accountable by conducting public oversight hearings on a regular basis. He cited emails recently released by Sen. Bernie Sanders (I-Vt.) showing HHS officials instructed then-CDC director Susan Monarez to route agency communications through political staff before release. Davidson said the answer going forward is “radical transparency and honesty from public health communicators, even when the message is unwelcome, along with an acknowledgment that public health itself has become politicized.”
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