A Texas Democrats sign hangs on a podium at a Democratic watch party following the Texas primary election on March 6 in Austin. | Eric Gay/AP Photo Texas Democrats look to single-payer in congressional races

Democrats hoping to wrest congressional seats away from diehard repeal-and-replace Republicans are campaigning on an unlikely issue for Texas — single-payer health care.

Across the country, many Democrats are trying to minimize internal battles on health care. But Democrats in this deep red state have also watched closely races where single-payer advocates have upset centrist primary opponents. And some believe that moving left on health care will mobilize new voters in primaries —and offer a shot at winning come November.


More than half the 22 Democratic House candidates competing in the Texas primary runoff next Tuesday openly tout their support for single-payer health care. On the Senate side, Democrat Beto O'Rourke, who handily won his March primary, will face Sen. Ted Cruz. Cruz built his reputation on shutting down down the government in a failed bid to stop Obamacare in 2013. O'Rourke says he supports strengthening the Affordable Care Act now but starting on a path to an eventual single-payer health system.

“One of the things that exists for us is a large, very large number of people who are progressive who are not participating in the ballot box,” said Wendy Davis, a Texas Democrat who unsuccessfully ran for governor in 2014. “I’ve heard the analogy before that we aren’t trying to get people to convert from Catholicism to Baptism, but trying to get people who are Baptist to come to church.”

Pulling up Texas' entrenched Republican roots is a tough task for Democrats, and the state is unlikely to lean left anytime soon. Still, the state's Democrats face a very different political climate in 2018. For starters, GOP attacks on the Affordable Care Act resonate less with voters.

“The Republican Party in Texas took a position that was more extreme than others, vilifying anything associated with the term Obamacare,” said Mark Jones, a political science professor at Rice University in Houston. “It’s less and less effective, every year that passes from the Obama administration.”

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For the first time in 25 years, Democratic candidates are running in every congressional race in Texas. Many of them, like Democrats across the country, have made health care their central campaign issue.

But Democrats in Texas believe that talking about health care gives them an even greater advantage. The state has the highest uninsured rate in the country. Its Republican attorney general is once again suing to overturn Obamacare.

And while the state remains one of 19 that hasn't expanded Medicaid, 95 percent of Democratic primary voters in March replied yes to a non-binding proposition asking if everyone in Texas should have a right to health care.

“Health care is one of our number one issues this election,” said Tariq Thowfeek, communications director for the Texas Democratic Party. “Our platform is far more progressive” than the national Democratic party's, he said.

Still, the issue of whether to support single-payer vs. the less provocative goal of expanding existing ACA protections has become divisive in the handful of races where Democrats believe they have a shot at flipping Republican seats.

That includes the 7th Congressional District, just west of Houston, which backed Hillary Clinton for president over Donald Trump. It has been represented by Republican Rep. John Culberson since 2001 and is home to many health care workers at the Texas Medical Center.

Primary voters winnowed the crowded Democratic field to Laura Moser, who embraces single-payer health care, and Lizzie Pannill Fletcher, who supports building on ACA coverage gains. They will face off again on Tuesday.

Fletcher, an attorney, believes that single-payer is too extreme a position for voters in the district.

“This is a traditionally Republican district that doesn’t think government is the solution to everything,” Fletcher said.

The DCCC published opposition research on Moser ahead of the March primary, arguing that she carries too much baggage to win the general election — and in the process drawing national attention for its attack on the more liberal candidate. Moser, described on her website as a "working mom turned progressive activist turned candidate," promised that if she prevails on Tuesday she won’t back away from single-payer.

“I hate it when Democrats use Republican talking points,” she said. “Obviously we aren’t going to wake up tomorrow with single-payer, but we have to stake out our position unapologetically.”

Elsewhere in Texas the divide is more muddled.

In the 21st Congressional District, where Republican Rep. Lamar Smith is retiring after more than three decades, the Democratic primary runoff pits progressive Mary Street Wilson against the more centrist Joseph Kopser, an Army veteran and former Republican favored by the national Democrats.

Kopser told POLITICO that he would support a single-payer health system if he had to vote on a bill. But he doesn’t talk about it on the campaign trail. Nor does he tout specific ideas like “Medicare-for-all” that could alienate conservative voters in the district, which stretches from Austin to San Antonio and west into the Texas Hill Country.

On the other hand, Wilson — a pastor and former math teacher whose first-place March finish was among the biggest primary surprises in the state — has been touting her support for a Medicare-for-all bill, believing it will appeal to older voters who dominate the district.

“I’m not just a bleeding-heart liberal saying everyone should have health care,” said Wilson. “I believe it’s a practical solution.”

But the polling power of single-payer is unclear. More than half the Democratic challengers who won the first round of primary voting outright include single-payer health care in their campaign platforms. None of the nine Democratic incumbents do. (Democrats currently hold 11 seats in the Texas delegation to the GOP's 24, with last month's resignation of Republican Rep. Blake Farenthold leaving one vacancy.)

In the general election campaign, Republicans are sure to argue that support for single-payer amounts to a tax hike — anathema to conservative Texans.

Even in blue California, single-payer has stalled in the state Legislature amid cost projections and worries about new taxes.

Still, a fire has been lit in Texas. Talk of single-payer health care won’t die down even if progressive candidates lose, said Jim Hightower, head of Our Revolution Texas, which is building on Sen. Bernie Sanders' 2016 presidential campaign message. Hightower is kicking off a 12-city tour this summer aimed at rallying support to introduce a Medicare-for-All bill in the 2019 state legislative session.

He admits that many single-payer-supporting candidates face tough odds in Texas, but believes this election is a key opportunity to build long term support.

“As my buddy Willie Nelson says,” said Hightower, “The early bird gets the worm, but the second mouse gets the cheese.”