The national discussion around Medicare for All has changed a lot since 2016.

Back then, when Senator Bernie Sanders (I-VT) advocated for such true universality in health coverage, many Democrats dismissed the idea out of hand. Hillary Clinton said single payer will “never, ever” happen, and some Democrats equated supporting Medicare for All with supporting the repeal of the Affordable Care Act.

Three years later, Sanders isn’t the only Democratic presidential candidate rooting for Medicare for All. Cory Booker, Kirsten Gillibrand, Kamala Harris, and Elizabeth Warren have all co-sponsored Sanders’s Medicare for All legislation. Tulsi Gabbard has been a co-sponsor in the House. And former HUD Secretary Julian Castro has also professed his support for such a program.

Polling has shown strong support for Medicare for All, with 85% of Democratic and even 52% of Republican voters supporting the policy, according to a Reuters–Ipsos survey. (Of course, the numbers fluctuate with the phrasing of the question – as always happens with polling.)

The Most Ambitious Bill to Date

In this context, Congresswoman Pramila Jaypal of Seattle released the most ambitious Medicare for All bill to date just over a month ago. It would cover hospital visits, primary care, medical devices, lab services, maternity care, prescription drugs, vision and dental benefits, and abortion services.

106 fellow Democrats signed on to Jayapal’s bill for its release, and one more – Lori Trahan (MA-03) – has joined since then. This is more than any other bill started with. Last session, Congressman John Conyers’s bill ended the session with 124 co-sponsors, although it began with just 52. (In the prior two sessions, the bill had a mere 63 and 62 co-sponsors.)

Swing District Shyness and Boldness

Unsurprisingly, most Democrats in swing districts shy away from supporting Medicare for All due to their political timidity or the attractiveness of health care industry fundraising. Only eight of the co-sponsors of Jayapal’s bill hail from swing districts: Matt Cartwright (PA-08), Jared Golden (ME-02), Josh Harder (CA-10), Katie Hill (CA-25), Ann Kirkpatrick (AZ-02), Mike Levin (CA-49), Katie Porter (CA-45), and Susan Wild (PA-07). They all represent districts where either Trump won or Clinton won only narrowly in 2016. Much credit to all of them.

But in Some of the Bluest Districts…

By contrast, there are 21 Democrats in districts where Obama and Clinton both won by more than 2:1 that have chosen not to sign on to the bill. What gives?

Butterfield, Clyburn, Cummings, Evans, Jeffries, Johnson, Lofgren, Moore, Sherman, and Sires have all been co-sponsors in the past. So why not now? Democrats, for the first time since January 2011, control the House and can change the discussion on health care in this country.

But some prefer to take bold stances only when they know nothing will happen.

Want to hear more about Medicare for All and single-payer? Listen to our discussion with National Nurses United on iTunes or in your browser below: