WASHINGTON — On the same November day next year when Americans will decide whether or not to keep President Trump in office for four more years, 468 members of Congress across the nation will defend their seats. And much as Democrats want to defeat Trump, they know they must retain the House of Representatives and compete for the Senate if they are to advance their agenda, regardless of who is president.

If the lower chamber were to revert to Republican control, Washington would return to the single-party dominance that Trump enjoyed during his first two years in office. Democrats managed to seize the House in 2018, in large part by running on a defense of the Affordable Care Act, President Barack Obama’s health care law that Republicans tried and failed to repeal during Trump’s first year in office.

But with the ACA settled law, at least for now, some Democrats want to go much further and get rid of private insurance altogether, putting the federal government fully in charge of the nation’s $3.65 trillion health care sector. The idea, first proposed by Sen. Bernie Sanders of Vermont and endorsed by many Democrats, is known as Medicare for All.

But with the brutal battle over the ACA in 2017 still fresh in many minds in Washington, some in the Democratic establishment think it is too soon to push for a radical expansion of the government’s power over one of the most complicated, fraught and expensive aspects of American life.

“A lot of people don’t want government insurance. I understand that,” recently acknowledged Sen. Sherrod Brown, D-Ohio, a progressive elder statesman in Congress respected for his ability to appeal to working-class whites.

In addition, there are growing worries that if the party’s presidential nominee runs on federalizing the American health care system, not only will Trump retain the White House, but Republicans will also achieve critical victories in so-called down-ballot congressional races by tethering candidates to a policy that may be far more progressive than what they support.

South Bend, Ind., Mayor Pete Buttigieg. (Photo: Scott Olson/Getty Images) More

Republicans are eager for that very outcome. “When the caricature of a far-left Democrat is no longer a caricature, but rather their actual presidential nominee, Republicans will have a field day defining their down-ballot candidates across the country,” Republican consultant Andy Seré said last month.

Proponents of Medicare for All say that federal control of the health care sector will dramatically expand coverage and, in time, reduce costs. They cite Americans’ worries about health care costs, as well as the fact that millions lack insurance altogether, as moral and political imperatives that can no longer be ignored.

But such arguments have done little to quell anxiety among centrists. And those anxieties spiked with the release of a Monmouth poll of Democratic voters in New Hampshire, a crucial early primary state where many a campaign has been broken (and a few have been reinvigorated). The poll found that while 56 percent of respondents wanted a public option for health care, thus giving the government a far greater role in the health care system than it has today, only 23 percent endorsed Medicare for All.

That same poll had Sen. Elizabeth Warren, the Massachusetts progressive, slightly ahead of former Vice President Joe Biden. Warren has endorsed the Medicare for All plan proposed by Sanders, who was third in the Monmouth poll. He was trailed closely by South Bend, Ind., Mayor Pete Buttigieg. The support enjoyed by Warren and Sanders hardly suggests a wholesale rejection of progressive health care proposals.