× Expand Matt Rourke/AP Photo Early caucus voting starts this weekend in Nevada; we will soon learn if this all-out campaign against Medicare for All moves the vote.

Within moments of winning the Democratic primary in New Hampshire, Bernie Sanders experienced something he has very rarely if ever experienced in his political life: an attack from a trade union. Many unions certainly supported Hillary Clinton in 2016, but they didn’t really go after Sanders, who is at the root a labor liberal, someone finely attuned to the concerns of union members, always the first to sign onto their bills, with advisers and aides plucked out of the labor movement.

Yet in Nevada, a state where Sanders took 47 percent of the vote in the 2016 caucuses, the powerful Culinary Workers Union (UNITE HERE Local 226) has distributed a flyer to all 60,000 members in English and Spanish via text and email, which states flatly that Bernie will “End Culinary Healthcare” and “Require ‘Medicare for All.’” As Alexander Sammon wrote last month, the Culinary Union leadership has been reluctant to give up its top-of-the-line health coverage. This is the second flyer in three days the union has dropped on the issue, but this one more directly attacks Sanders, signaling an escalation of its opposition just 11 days out from the caucuses.

The Culinary Union, seen by some as an outgrowth of the political machine of longtime Senate Democratic Leader Harry Reid, staffs virtually all of Las Vegas’s major hotels and provides health coverage to 130,000 members and their dependents. They are seen as a political kingmaker in Nevada, providing ground troops for endorsed candidates and successfully turning out voters.

More from David Dayen

The union has yet to endorse in the presidential primary. It’s hard to know whether the antipathy to Medicare for All is coming from the union leadership or the rank and file, and how much impact this apparently coordinated campaign will have. But this presents a new challenge for Sanders, with an attack on his signature issue coming from part of the labor movement, which he has championed for decades.

The flyer purports to compare six leading presidential candidates on “Culinary Union issues.” But on “good jobs” and “immigration,” the candidates are all listed as having identical views. Only on healthcare is there any divergence. While Joe Biden, Pete Buttigieg, Amy Klobuchar, and Tom Steyer will “Protect Culinary Healthcare” according to the flyer, Sanders will end it. For Elizabeth Warren, whose struggles over defining her position on healthcare are well-documented, the Culinary Union softens their tone, writing that she will “Replace Culinary Healthcare after 3-year transition or at end of collective bargaining agreements.” So this “informational” flyer really boils down to a hit on Sanders for wanting health coverage for everyone in America.

There was a minor kerfuffle earlier in the primary cycle over Medicare for All taking away union benefits for which they bargained and gave up wages, but this is not a monolithic labor sentiment. Several unions have endorsed Medicare for All, though for some, it’s unclear whether that means anything beyond being an on-paper assent.

In August, Sanders changed his Medicare for All plan to accommodate organized labor, allowing unions to negotiate for “wrap-around” health care services and to ensure that employer savings flow to union members in wages or benefits. Indeed, future contract negotiations where health care is off the table would increase leverage for unions to bargain for higher wages or better working conditions.

Your donation keeps this site free and open for all to read. Give what you can... SUPPORT THE PROSPECT

It’s unclear who, if anyone, could benefit from this attack on Sanders, especially if the union continues to not endorse any candidate.

But none of that has satisfied the Culinary Union. Who is dictating this posture, and how deep into the rank and file does it go?

Yvanna Cancela, the Culinary Union’s former political director who is now Nevada’s first Latina state senator, endorsed Joe Biden even before he announced for president. Cancela directed the union’s rise to prominence and was a leading campaign operative for Harry Reid. So you can surmise that the Biden ties are rubbing off on the union leadership’s stance.

However, Biden is a dead man walking in the primary race, and has the burden of defending the Obama administration’s deportation record to a heavily Latino union. In fact, it’s unclear who, if anyone, could benefit from this attack on Sanders, especially if the union continues to not endorse any candidate. Both Buttigieg and Klobuchar have little support among Latino voters in a state that’s 29 percent Latino. Warren has done some Latino outreach, but her Medicare for All stance has been just as disfavored by the union. Mike Bloomberg isn’t competing here. Bizarrely, Steyer, who has been saturating the state with campaign ads and maintains ties through organizing investments in years past, could be the main beneficiary in Nevada.

For their part, the Sanders campaign, which has been conducting intensive Latino outreach, believes they have made in-roads among actual Culinary Union members, through canvassing at homes and work sites and Spanish-language literature. Representative Alexandria Ocasio-Cortez (D-NY) did a Nevada town hall entirely in Spanish and could be an asset here. Outside of a fading Biden, Sanders is the only candidate competing in Nevada who’s shown much of a pulse with voters of color.

Early caucus voting starts this weekend in Nevada; we will soon learn if this all-out campaign against Medicare for All moves the vote. It’s a decent indicator of the fervent pushback we’re sure to see if Sanders gets elected; even natural friends like unions can see themselves as stakeholders when it comes to healthcare. The story of health reform in America is a story of people zealously defending what they have and resisting changes, even if the overall system is inadequate.

If Sanders manages to win over members with his message, it would signal that the “keep what you have” fears aren’t as resonant anymore. In New Hampshire, 60 percent of voters in the Democratic primary supported replacing private health insurance with a government plan, matching voter polling in Iowa. If even the Culinary Union’s best efforts cannot pierce this support among its members, maybe we’ve reached the beginnings of a tipping point.