Most of the prominent Democrats eyeing 2020 presidential bids — including Sens. Kirsten Gillibrand of New York, Cory Booker of New Jersey and Elizabeth Warren of Massachusetts — champion the idea of “Medicare for all,” suggesting it’s become almost a litmus test for the party’s base.

But the notion of government-funded health care has proved a tough sell to Democratic voters in swing districts that will determine control of the House.


Many Democratic candidates who made that a centerpiece of their campaigns in key districts this year lost their primaries, in some cases getting clobbered by rivals who offered vaguer health care plans or backed a more incremental approach. Democratic primary voters in battleground districts in Iowa, Texas, Kansas and New York passed over candidates who emphatically supported single payer.

“The problem is Medicare for all just isn’t one of those litmus tests for Democratic primary voters,” said John Anzalone, a veteran Democratic pollster whose firm helped defeat a single-payer advocate in an Iowa swing district this year. “Voters are smart enough to know that Medicare for all isn’t going to happen right now, or maybe ever.”

Just 16 percent of Democrats identified support for a national health care plan as the No. 1 issue in determining their vote, according to a Kaiser Family Foundation survey last month.

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“By and large, I think Democrats have been pretty pragmatic in their primaries,” said Ian Russell, a Democratic strategist and former national political director at the Democratic Congressional Campaign Committee. “They’ve nominated candidates who want to expand access to affordable health care, but haven’t gotten bogged down with the specifics of a legislative package that can give fodder to their opponents.”

Democrats learned that lesson the hard way: Republicans bludgeoned Obamacare for four straight election cycles — helping them win total control of the federal government — without ever fully explaining how they’d replace the health care law. That’s an electoral blueprint that could be attractive for Democrats, who see an advantage on health care issues for the first time in almost a decade.

“I think it’s a very, very similar situation,” said Mollyann Brodie, Kaiser’s senior vice president for public opinion and survey research. “I think it can be used in a similar way. It can be a rallying cry.”

Several Democratic strategists say there are plenty of other reasons besides their crusade for universal, government-funded health care that may have doomed the losing candidates — including that single payer was simply not a motivating factor for many voters.

Certainly, polling shows increasing support for a national health plan, in an apparent backlash to GOP efforts to dismantle Obamacare. More than half of all Americans support a national health plan, up from 40 percent two decades ago, according to Kaiser. And among Democrats, 75 percent now favor it.

Polling also finds that support for Medicare for all — as well as other descriptions of a government-funded health care system — begins to erode when more details are sketched in. For instance, pointing out that funding such a system might require higher taxes drives up opposition by 19 percentage points, according to Kaiser’s polling data.

A few single-payer advocates have won primaries in swing districts, including Kara Eastman, who scored an upset in Nebraska’s 2nd District over ex-Rep. Brad Ashford. | Nati Harnik/AP Photo

Staying out of the single-payer debate, party strategists say, could help Democrats in the general election, when they’ll have to appeal to moderates skeptical of government-run health care. Earlier this year, the DCCC warned candidates about embracing single payer, hoping to avoid Republican attacks on “socialized” medicine.

There are some strong single-payer advocates who won primaries in swing districts. Most notably, Kara Eastman pulled off one of the biggest upsets of the primary season in Nebraska’s 2nd Congressional District, knocking off former Congressman Brad Ashford.

“I think health care in general helped get us the win,” said Eastman, who is looking to unseat GOP Rep. Don Bacon. “It’s something that’s on the forefront of almost everybody’s minds right now.”

Another outlier is Katie Porter, who is emphatically pushing Medicare for all in her bid to unseat Rep. Mimi Walters (R-Calif.) in an Orange County district that tilts slightly red.

Republicans, who aren’t eager to campaign on health care after the party’s stumbles on Obamacare repeal, see an opportunity to seize on single payer to portray Democrats as irresponsible, tax-and-spend liberals.

“[Democrats] can choose to run on it, but there’s just no evidence that it works,” said Jim Hobart, a Republican pollster with Public Opinion Strategies, citing Vermont’s failed effort to pursue single payer in 2014. “Even if it were feasible, it would mean just an absolutely astounding tax increase.”

Failed Democratic candidates who ran hard on Medicare for all didn’t attribute their defeats to health care. Laura Moser, who was drubbed by a 2-to-1 margin in a Houston-area district that favors Republicans by 7 percentage points, blames her loss on DCCC attacks portraying her as unelectable.

“I still stand by all of the issues I fought for in the campaign,” Moser said. “But in the end, I think people want to win in November.”

Jeff Beals, who made Medicare for all the cornerstone of his losing campaign in a sprawling district in New York’s Catskills region, contends Democratic primary voters are making a mistake by electing candidates who offer only vague promises of support for universal health care.

“Democrats have been campaigning for health care reform for decades and the public hasn’t been demanding details,” said Beals, who finished fourth in a seven-candidate field. “The result has been that victory at the polling booth has never wound up meaning fundamental change to the system everybody was voting against.”

Democrats believe their intraparty squabbles over single payer will matter little in the general election, when they hope to capitalize on the GOP’s unpopular health care agenda. Voters favor Democrats on health care issues by a 16-point margin, according to a Pew Foundation poll in June.

That Democratic advantage is translating onto the airwaves. Sixty-three percent of Democratic ad buys in House races focused on health care, compared with just 15 percent for Republicans, according to a recent analysis by the Wesleyan Media Project.

“It is one of the overriding issue problems that [Republicans] have in this election,” said Joe Trippi, a veteran Democratic strategist. “I think a lot of seats are going to hang on health care and real anger at what the Republicans have done.”