A majority of likely Iowa Democrat caucus voters prefer a public option, compared to only one-fifth of Democrats who prefer Medicare for All, according to a poll released this week.

A Monmouth University poll found that 56 percent of likely Iowa Democrat caucus voters say that they would prefer to opt into Medicare alongside other health insurance options on the Obamacare exchanges, otherwise known as a public option, compared to only 21 percent that prefer Medicare for All, 13 percent that would prefer tighter cost regulations on the current Obamacare system, and only four percent that want to leave the current system intact.

The poll could serve as a dire warning sign for more progressive 2020 Democrat presidential candidates such as Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-MA), who back Medicare for All, and could signal good fortune in the Iowa caucuses for former Vice President Joe Biden and South Bend, Indiana, Mayor Pete Buttigieg, who prefer a public option.

The Monmouth survey found that Biden had 28 percent support amongst Iowa Democrat voters, while Warren had 19 percent support, which is up from seven percent four months ago.

However, despite Iowans’ preference for a government health insurance public option, one study found that a public option could decimate America’s rural hospitals.

A study commissioned by the Partnership for America’s Health Care Future and conducted by Navigant Consulting found that “adding a government-run insurance plan could decimate rural hospitals.”

The study found that as many as 55 percent of rural hospitals, or 1,037 hospitals across 46 states, could become at risk of closure from a public option. The closure of those rural hospitals represents more than 63,000 staffed beds and 420,000 employees.

Lauren Crawford Shaver, the executive director of the Partnership, said that despite many Democrats’ attempts to portray the public option “as a much more moderate alternative to ‘Medicare for all,’ the truth is the public option would be also damaging, potentially putting the health and well-being of our rural communities at risk.”

The Monmouth survey was conducted by telephone from August 1 to 4 with 401 likely Iowa Democrat voters and has a margin of error of 4.9 points.

Sean Moran is a congressional reporter for Breitbart News. Follow him on Twitter @SeanMoran3.