Beto O'Rourke Beto O'RourkeJimmy Carter says his son smoked pot with Willie Nelson on White House roof O'Rourke endorses Kennedy for Senate: 'A champion for the values we're most proud of' 2020 Democrats do convention Zoom call MORE has offered conflicting messages on 'Medicare for all,' drawing fire from progressive activists who accuse him of backing off an idea they say he once supported.

The issue has become an important litmus test for those on the party's left and an early question for O'Rourke, who announced his presidential run on Thursday.

O’Rourke previously supported a full-scale single-payer plan, writing in a 2017 Facebook post, “We need a single-payer health care system for all Americans.”

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But he backed off the idea during his Senate run in Texas last year, calling for “achieving universal health care coverage — whether it be through a single-payer system, a dual system or otherwise.”

This week, O'Rourke again moved away from full single-payer health care, saying he supports giving people the option to buy into Medicare. That's far from the approach being pushed by 2020 rival and progressive icon Sen. Bernie Sanders Bernie SandersButtigieg stands in as Pence for Harris's debate practice Bernie Sanders warns of 'nightmare scenario' if Trump refuses election results Harris joins women's voter mobilization event also featuring Pelosi, Gloria Steinem, Jane Fonda MORE (I-Vt.), who would mandate Medicare for everyone and abolish employer-sponsored coverage.

“It’s very disheartening and misleading because he did flirt with Medicare for all during his Senate race,” said Waleed Shahid, communications director for the progressive group Justice Democrats and a former Sanders staffer.

“Beto will lose the votes of progressives and young people by not coming out in favor of single-payer Medicare for all,” he added.

O’Rourke told CBS News on Thursday that Medicare for all is “one of the possible paths” to expanding health care coverage but made it clear he prefers a different approach that would allow people to keep their employer-based coverage if they wanted and leave Medicare as an option.

“I think the fastest way to get there is to ensure that people who have insurance that they like through their employer are able to keep it and that we complement that with those who can purchase Medicare, be covered by Medicaid,” O’Rourke said in the interview.

He separately said in Iowa this week that he likes a bill along those lines from Reps. Jan Schakowsky Janice (Jan) Danoff SchakowskyAhead of a coronavirus vaccine, Mexico's drug pricing to have far-reaching impacts on Americans With Biden, advocates sense momentum for lifting abortion funding ban Hillicon Valley: Facebook removed over 22 million posts for hate speech in second quarter | Republicans introduce bill to defend universities against hackers targeting COVID-19 research | Facebook's Sandberg backs Harris as VP pick MORE (D-Ill.) and Rosa DeLauro Rosa Luisa DeLauroOvernight Health Care: CDC pulls revised guidance on coronavirus | Government watchdog finds supply shortages are harming US response | As virus pummels US, Europe sees its own spike Trump HHS official faces firestorm after attacks on scientists Ahead of a coronavirus vaccine, Mexico's drug pricing to have far-reaching impacts on Americans MORE (D-Conn.).

Other presidential candidates, including Sens. Kamala Harris Kamala HarrisButtigieg stands in as Pence for Harris's debate practice First presidential debate to cover coronavirus, Supreme Court Harris joins women's voter mobilization event also featuring Pelosi, Gloria Steinem, Jane Fonda MORE (D-Calif.), Elizabeth Warren Elizabeth WarrenHarris joins women's voter mobilization event also featuring Pelosi, Gloria Steinem, Jane Fonda Judd Gregg: The Kamala threat — the Californiaization of America GOP set to release controversial Biden report MORE (D-Mass.) and Cory Booker Cory Anthony BookerBipartisan praise pours in after Ginsburg's death DHS opens probe into allegations at Georgia ICE facility Democratic lawmakers call for an investigation into allegations of medical neglect at Georgia ICE facility MORE (D-N.J.), are backers of the Sanders plan, in contrast to O’Rourke.

That's certain to keep the issue in the limelight — and pressure on O'Rourke.

Neil Sroka, communications director for the progressive group Democracy for America, said O’Rourke was professing “corporatist gobbledygook” on health care.

O'Rourke's struggles with Medicare for all also highlight how the issue has created a rift in the Democratic party. Many progressives say backing single-payer health care is a necessity for the eventual nominee.

But more establishment Democrats think it is a smarter strategy politically to allow people to keep their employer-sponsored coverage if they like it rather than mandating an end to it.

Republicans have already seized on the elimination of private insurance coverage under Medicare for all as a leading line of attack.

A Kaiser Family Foundation poll in January found that support for Medicare for all drops from 56 percent to 37 percent when people are told the proposal would mean the elimination of private insurance companies.

A proposal along the lines of what O’Rourke is suggesting — to make Medicare an option for all — has the support of 74 percent of the public, the poll found.

O’Rourke also indicated Thursday that he could try to work with Republicans on the issue, a far different tone than that of Sanders, who has called his presidential run a continuation of the "political revolution" he says started in 2016.

“I’m convinced that we will have to work from as much common ground as possible,” O’Rourke told Radio Iowa on Thursday. “No one person and perhaps no one party can force the decision on this. This has to be something that America comes together on.”

Adam Green, co-founder of the Progressive Change Campaign Committee (PCCC), pushed back on O’Rourke’s openness to working with GOP lawmakers.

“The larger problem here is his entire theory of the case on being president,” Green said.

Green noted that PCCC supported O’Rourke in the Senate race last year but questioned his more recent remarks.

“It’s becoming increasingly clear that if someone wants a Medicare for all champion in the White House ... that Beto is kind of taking himself out of consideration for that champion role, which is rather unfortunate,” Green said.

For many progressives, there are worries that O'Rourke is pushing a centrist message that ignores their priorities.

In his challenge against Sen. Ted Cruz Rafael (Ted) Edward CruzTrump argues full Supreme Court needed to settle potential election disputes Press: Notorious RBG vs Notorious GOP The Hill's Morning Report - Sponsored by Facebook - Washington on edge amid SCOTUS vacancy MORE (R-Texas), O'Rourke generated massive enthusiasm among Democrats, but critics also said he offered few policy specifics.

Whether O'Rourke can do that again in what is expected to be a crowded Democratic primary field and with progressives rallying around Medicare for all is an open question.

Democratic strategist Brad Bannon said O’Rourke in general has put more of an emphasis on charisma and appeals to unity rather than on detailed policy proposals.

“It seems to me he's running a personality campaign as opposed to a policy campaign,” he said.

But he added that O'Rourke could be an appealing pick for Democrats focused primarily on defeating President Trump Donald John TrumpOmar fires back at Trump over rally remarks: 'This is my country' Pelosi: Trump hurrying to fill SCOTUS seat so he can repeal ObamaCare Trump mocks Biden appearance, mask use ahead of first debate MORE in the general election, which he called an "overriding concern" for many.

Jonathan Chait, a prominent center-left writer for New York magazine, made a similar point on Thursday.

“He is saying he has natural gifts as a political communicator, and believes he should put them to use for the purpose of beating Donald Trump and otherwise making the world a better place,” Chait wrote about O'Rourke. “This is a good reason to run for the presidency!”

But progressives insist they won't let O'Rourke off the hook regarding Medicare for all.

“When Beto O'Rourke is being outworked from the left by Cory Booker, you know that there’s a problem,” Sroka said.

Updated on March 18 at 2:36 p.m.