A Democratic nominee who supports replacing private health insurance with a government-run system would lose union voters in battleground states Democrats must win to reverse President Trump's 2016 victory, according to union officials.

Democrats risk ceding the industrial Midwest to President Trump, labor operatives warned in interviews with the Washington Examiner. Trump victories in Rust Belt states such as Michigan, Pennsylvania, and Wisconsin demolished what Democrats figured to be a "blue wall" cemented by hard hats who would support the Democratic nominee, Hillary Clinton.

Among the leading Democratic contenders, Elizabeth Warren and Bernie Sanders propose abolishing private insurance and turning healthcare over to Washington. Kamala Harris, who rocketed into the top tier after an effective debate performance, has hedged. On a few occasions, she has pledged to put the government in complete control of healthcare, while at other times she has said she supports maintaining access to private insurance.

Labor leaders in heartland battlegrounds said rank-and-file members support former President Barack Obama's Affordable Care Act, which includes private plans, and are jealously protective of expansive health benefits won in tough negotiations with corporate employers. A nominee who proposes replacing Obamacare with a government-only system risks pushing this core Democratic constituency into the arms of Trump.

“We don’t support the ‘Medicare for all’ structure. We certainly aren’t in support of a government-control, government-run system at the expense of those that currently have employer-provided, or union-negotiated, plans,” said Harold Schaitberger, general president of the International Association of Firefighters. The union is backing Joe Biden, in part because of his commitment to Obamacare and private coverage. “For members of our union, it would be a significant disincentive.”

Ditto, said Gary Steinbeck, an official with the AFL-CIO labor council in Mahoning and Trumbull counties in Ohio. The union-heavy region was for generations a hotbed of votes for Democratic presidential candidates until 2016. Trump made significant inroads there, and the Democrats’ ability to recover lost ground and reclaim this swing state could hinge on the position their nominee takes on healthcare.

“The members have a comfort level with private insurance, and to eliminate that would be a problem,” said Steinbeck, who spent a quarter century with United Steelworkers. “It would definitely create a problem trying to get votes from labor folks.”

Healthcare is a key priority for Democratic voters, and a debate over how to proceed is playing out in the party’s 2020 primary, with some candidates proposing to junk private insurance and others proposing to strengthen the Affordable Care Act, or Obamacare, by adding an option to purchase Medicare-style coverage from the federal government.

The labor community is not monolithic on the issue. Some are wary of offending any of the candidates and decline to take a clear stance.

Unions representing nurses and workers in some other industries, plus the public sector, tend to back a government takeover of healthcare.

United Automobile Workers, based in Detroit, declined to pick sides. But in a statement provided to the Washington Examiner, the union focused on advocating for preserving Obamacare. The Trump administration is asking the federal courts to throw out the law, arguing it is unconstitutional.

“The UAW is focused on the millions of Americans that face peril over anti-worker court challenges to the ACA that can negatively impact the economy and jobs,” the United Automobile Workers said. “Regardless of how this sorts out, the ACA is an important first step and the UAW has a historic role in working toward health care as a right and not a privilege for all Americans.”

Granted anonymity, a UAW official in a contested Rust Belt state was more pointed in discussing how rank-and-file members might respond to a Democrat who pitches replacing Obamacare with government-funded healthcare

“I’m not opposed to a public system as long as there’s a private option. People should have a right to have a private option,” this official said. “We have healthcare provided through our collective bargaining agreement, and so obviously we wouldn’t want to see our healthcare deteriorate.”

Polling shows voters are leery of a government takeover and hesitant to relinquish private insurance, although they are dissatisfied with aspects of their coverage, particularly the cost.

A recent Morning Consult poll revealed the complexity of the issue.

In the survey, a majority opposed “Medicare for all” when told it would mean an end to private insurance and the loss of access to current medical providers. When told they could retain access to their providers, a majority were supportive.