Cigna reportedly threatened to leave Connecticut, a state where the economy depends heavily on the presence of insurance companies, if the state legislature approved a public health insurance option, according to a new report.

The Hartford Courant, quoting state comptroller Kevin Lembo, revealed the apparent ultimatum on Wednesday. The health insurer has denied making an explicit threat, while acknowledging they were lobbying hard against a plan supported by Democratic lawmakers and Gov. Ned Lamont:

Cordani made the threat as legislators and other insurance carriers were negotiating the legislation Tuesday night, Lembo said. Brian Henry, a spokesman for Cigna, said the insurer made no such threat. “We never said anything like that,” he said. “We said it was not good for the state, the citizens or the industry.”

Connecticut lawmakers have been exploring a bill that would set up a state-subsidized health insurance plan, offer additional subsidies beyond those authorized by the Affordable Care Act, and establish an individual mandate requiring the state’s residents to purchase health insurance or pay a penalty. It would rank among the more ambitious state proposals to expand health care, though the public option is now in doubt in the face of the industry’s opposition.

While (allegedly) giving lawmakers an ultimatum might sound dramatic, it’s perfectly in keeping with how the industry has approached the fledgling debate about expanding health coverage beyond the ACA. Industry groups in Washington have mobilized against every kind of government health care expansion, from single payer to letting 50-year-olds buy into Medicare. Meanwhile, they were largely bit players during Republican attempts to roll back or repeal Obamacare in 2017. The industry views current proposals for single-payer health care as an existential threat and even considers more incremental plans, like a public option, to be simply a stalking horse for a full government takeover. They are defending a role for private carriers in the market.

Heading into the 2020 election, the industry views the idea of expanded government health care, more than any specific candidate, to be their primary opponent.

The health care industry versus Medicare-for-all

The health care industry — doctors, hospitals, insurers, pharmaceuticals — has united in the lobbying coalition Partnership for America’s Health Care Future in order to stop Medicare-for-all. That organization aggressively denounces single-payer at every opportunity and has condemned proposals like a public option or letting people 50 and older buy into Medicare.

“Let’s do Alexander-Murray,” a top trade association president told me recently, referring to the bipartisan Obamacare stabilization plan from Sens. Lamar Alexander (R-TN) and Patty Murray (D-WA) that fizzled out after the Obamacare repeal failed. “Make the individual market better, which we clearly could do; it wouldn’t cost that much money.”

Industry insiders expected former vice president Joe Biden to, at most, support a public option that allows some or all people under 65 to buy into Medicare. The Biden campaign has indicated that it is the kind of proposal he would support, though they haven’t yet released a specific plan.

“The industry would just like to see a candidate who would be responsible and be pragmatic,” this person said. “From the industry standpoint, it’s like, what was all the energy about 2010? Biden would be more sympathetic toward that.”

Sen. Bernie Sanders has made Medicare-for-All something of a litmus test for the primaries, and several of his opponents — Sens. Elizabeth Warren, Kamala Harris, Cory Booker, and Kirsten Gillibrand — have signed on to his bill. Not every 2020 Democrat is backing single-payer, of course. Pete Buttigieg, Beto O’Rourke, and Amy Klobuchar talk about alternative plans that don’t go as far as the single-payer system envisioned by the Vermont senator.

But it’s Biden who’s leading the polls, edging out Sanders for the most part, while the other lesser-known candidates still trail behind. He’ll likely position himself as the most viable center-left alternative to Sanders, the best bet to beat Trump in the general election. The industry obviously views the vice president as the guy on their side.

“This encapsulates a liberal versus a moderate in people’s minds. People want to beat Trump. They know a socialist can’t. The government isn’t going to fix everything,” a Democratic health care lobbyist said. “To that extent, people are waiting for” a candidate like Biden who wants more incremental improvements.