Since his run for the Democratic nomination in the 2016 presidential election, Senator Bernie Sanders of Vermont has been one of the most visible faces of the left in the United States. And he believes that it’s no accident that several progressive policies have taken center stage in the 2018 midterm elections.

With a presidential campaign that spoke especially to younger voters, Sanders cemented his position as not just a senator with decades of experience, but as a powerful force in liberal politics that would force the Democratic Party to adjust its strategies. His support for democratic socialism, Medicare for all, and other progressive polices helped set the stage for a major shift within the Democratic Party.

Two years later, with the 2018 midterm elections looming, Sanders spoke with Teen Vogue about how the Democratic Party has changed since his presidential run, what’s at stake in this year’s voting, and how he views supporting Democrats who might break from the party line on issues like reproductive rights.

Teen Vogue: Let’s talk about the 2018 midterms. What is at stake?

Bernie Sanders: This midterm election, in my view, is the most important midterm election in the modern history of this country. And what’s at stake is whether we continue one-party, right-wing reactionary rule in Washington, in which we have a Congress that follows a bigoted, racist, sexist, homophobic president — who also is a pathological liar — or whether we stand up and fight back for justice for all people. That is what is at stake.

What’s at stake is that this is an unprecedented election because we have an unprecedented president who is doing very, very serious harm to millions of Americans. And if we want to change the direction of the country and move toward a system of justice — economic, social, racial, environmental justice — we have got to vote and we have to see young people coming out at a much higher level than they have ever voted in the past.

TV: You’ve spent a lot of time on the campaign trail this year. What are the big issues you’re hearing from people?

BS: I would say that the major issue that I hear is healthcare. And people understand that the Republicans have not given up on their desire to throw tens of millions of people off the healthcare they currently have. As you may recall, they came within one vote of repealing the Affordable Care Act. The late Senator John McCain was the deciding vote.

Furthermore, [it’s] no question in my mind that they are now trying to get the Supreme Court to rule the Affordable Care Act unconstitutional, and if that happens, what we’ll see is that people with pre-existing conditions will no longer be able to get the insurance they need at an affordable cost.

So, I’m hearing a whole lot about healthcare. And I’m also hearing that the American people want us to move toward a Medicare-for-all, single-payer system, which will finally do in this country what every other major country does, and that is guarantee healthcare to all people as a right.

TV: So, is healthcare the first thing on the agenda if Democrats take back Congress?

BS: In my view, healthcare will be right up there. What will be up there is moving forward to a Medicare-for-all, single-payer system. And the first part of that effort — it’s a four-year phase-in — is to lower the age of eligibility for Medicare from 65 to 55 and to cover all of the young people in this country.