Supporters of U.S. Senator Bernie Sanders hold signs during an event to introduce the Medicare for All Act of 2017. Photo: Alex Wong/Getty Images

While the midterm elections, nationally, were a referendum on Trump, the blue wave that propelled the Democrats back into control of the House was also driven by the issues. One of the signature issues for the Democrats was Medicare for All, which seeks to abolish private insurance, replacing it with a single government health-care program for all Americans. But while candidates found Medicare for All a galvanizing and powerful slogan to run on, some of them seem to be walking back or moderating their stances now that they’ve been elected. This political two-step reveals a fundamental challenge to the future prospects of the progressive policy.

Two bills in the House and Senate to enact Medicare for All will be reintroduced this session by Vermont senator Bernie Sanders and Washington State Democrat representative Pramila Jayapal. With the Republicans in control of the Senate and Trump as president, the bill is less live legislation than it is a very important symbol.

Jayapal is head of the 78 member Medicare for All Caucus in the House and the Medicare for All PAC, which supported eight Democrats from the center to the left in their 2018 runs. In the end, five of the eight won. Jayapal told New York that her PAC and caucus intentionally endorsed Democrats like Representative Harley Rouda, a California moderate, whose politics stray to the center and the right, to make the point that universal health care is a policy with cross-partisan and cross-ideological appeal. “I don’t think universal health care is just a progressive idea,” said Jayapal, who cited the fact that the policy polls well with all Americans.

But Rouda, who asked his supporters to sign a petition supporting Medicare for All in October 2017, and reaffirmed his position the following spring during primary season, hedged his position in the general election, on his way to unseating Republican Dana Rohrabacher. By the time it hit his issues page, Rouda was talking about Medicare for All as a “long-term goal,” and pitching voters on the generic principle of making sure that “health care coverage is a right for all Americans.” Rouda’s office declined to comment for this article.

Rouda is not alone — first-term Democrat representatives Katie Hill, Susan Wild, Colin Allred, Josh Harder, and Kim Schrier all flipped Republican seats and each indicated support for Medicare for All at least once while on the campaign trail. But today, all but Harder have either qualified or walked back their support for the policy.

While Jayapal recruited candidates from across the ideological spectrum of the Democratic Party to illustrate the broad viability of Medicare for All, once they get into office, moderate Democrats tend to join moderate Democratic coalitions. And those coalitions tend not to support progressive policy. For instance, a number of congressional freshmen who ran on Medicare for All have joined the New Democrat Coalition caucus, a centrist group which explicitly came out against Medicare for All this year and prefers health-care policy that prioritizes protecting insurance markets. The New Democrat Coalition, through its communications director Natasha Dabrowski, did not respond to multiple requests for comment for this article.

Hill, who joined both the New Democrat Coalition and the Congressional Progressive Caucus, said it was “time for universal health care” in a campaign ad and name-checked Medicare for All in a Facebook video. But since the election, Hill seems to have decided that the time for Medicare for All is, instead, at some unspecified point in the future. “Katie believes that Medicare for All is a system we should be striving towards,” said Kassie King, Hill’s communications director, in a statement to Intelligencer. “Getting it right will require infrastructure and investment. Katie supports creating that infrastructure so that when the time comes that it makes sense to implement Medicare for All, it has the tools to succeed.”

Hill’s decision to align herself with both the center and left, King added, is part of the congresswoman’s “pragmatic” approach to achieving progressive goals. “In this way, she is the perfect fit for [both] the New Dems and the Progressive Caucus,” said King.

Wild, Hill’s fellow freshman who also caucuses with both the New Democrats and the CPC, tried to redefine the policy by borrowing the terminology without the ideology. While she initially promised to “passionately advocate for issues like Medicare for All,” she retreated from her stance two months later, saying instead that she supported a “Medicare for All–style plan that would ensure affordable coverage for all Americans.” Wild’s office declined multiple requests to comment for this article.

Wild isn’t the only new member of the Democratic majority whose position on Medicare for All includes redefining its meaning. Colin Allred, the new Democrat representative for Texas’s 32nd District, said via Twitter on January 27, 2018, that he was in favor of the policy.

Six months later, during an interview with Evan Smith, CEO of the Texas Tribune, Allred explained what he thought “Medicare for All” meant. According to Allred, the policy could mean many things and shouldn’t be interpreted to simply mean government health care. “It’s a Medicare buy-in,” Allred said. In a statement, Allred’s office clarified further. “Congressman Allred has always supported a strong public option, like a Medicare buy-in, as a pathway to universal coverage,” said Allred’s communications director Josh Stewart.

Central Washington’s Schrier supported Medicare for All as well — but her office said last fall that the “Medicare for All” Schrier supported was not the “Bernie Sanders plan.” “Kim has her own plan that is separate and distinct from Medicare for All,” Katie Rodihan, a Schrier spokesperson, told Politifact in October. Schrier, whose office would not provide comment for this article, apparently supports a Medicare buy-in.

There are a slew of bills, introduced or suggested by other members of Congress and influential think tanks like the Center for American Progress, which use the language of Medicare for All but advocate for wildly different policies. They include three separate Medicare buy-in bills, a Medicaid buy-in bill, and CAP’s “Medicare for All” bill, among others. The diversity of approaches has created ambiguity that politicians don’t seem particularly eager to clear up — “Medicare for All” is a galvanizing rallying cry.

All bills expand coverage, according to a Vox analysis, but none save the Sanders-Jayapal proposal would enact fundamental restructuring of health care and abolition of private insurance — the traditional meaning of Medicare for All.

The retreat from full-throated support for Medicare for All in an environment in which that support is largely symbolic is not promising for its future passage. If these marginal supporters of Medicare for All waver or moderate when it has no chance of becoming law — any such bill passed in the House would die in the Senate — then what will they do if Democrats control both chambers and the stakes become real?

The optimistic scenario for belief that the next Democratic government will pass Medicare for All is that the center of the party continues to move left. Jayapal told New York that Americans understand the idea of universal health care as distinct from the left — the policy’s crossover appeal is how change happens. Medicare for All may have started off as a progressive idea, but, as with not taking corporate PAC money, it became a mainstream Democratic idea in the midterm election. That means that the hostility from the New Democrat Coalition to universal health care is shortsighted, said Jayapal.

“It’s a really outdated idea from the leadership, or whoever is defining the agenda for New Dems, to not realize this boldness around universal health care may be a winning strategy for them,” said Jayapal.