WASHINGTON — Once regarded as radical, proposals to create a government-run health care system serving all Americans are making inroads among mainstream Democrats.

But Nevada’s federal lawmakers aren’t exactly jumping on the Medicare-for-all bandwagon.

Only one of the state’s six members of the U.S. Congress — Las Vegas Democrat Dina Titus — has signed on to legislation that would replace private health insurance companies with a Medicare system serving all U.S. residents, not just those 65 and older or those who have disabilities.

The other Democrats in the delegation want to take a more incremental approach to health care reform by building on the Affordable Care Act (ACA), the Obama-era law that expanded access to health insurance but left the private health insurance system intact.

“I believe health care is a right, not a privilege, and my number one focus is protecting and expanding the ACA,” Democratic Sen. Jacky Rosen said in a statement.

A spokesperson for Democrat Catherine Cortez Masto did not return a request for comment. But Nevada’s senior senator has also dismissed Medicare for all, telling reporters earlier this year that she supports other ways to expand access to health care coverage.

Neither Rosen nor Cortez Masto has signed on to Senate Medicare for all legislation championed by Bernie Sanders.

In the House, Democratic Rep. Susie Lee (3rd District) wants to “defend the ACA and find solutions that can improve its coverage,” according to spokesman Jesús Espinoza.

So does Rep. Steven Horsford, a Democrat from the 4th District. “We’ve already made important progress,” he said in a statement, noting that more than 400,000 Nevadans have acquired coverage since the ACA became law in 2010. “However, we must continue to work together to protect health care coverage for individuals who like their current plan.”

Rep. Mark Amodei – the state’s lone Republican in Congress whose second congressional district covers much or rural Nevada as well as Washoe County – doesn’t support Medicare for all either. Amodei’s office cited estimates that Medicare for all could cost the federal government $32 trillion over a decade. “The price tag is so massive that even if Congress doubled every American’s taxes, we would still not generate enough revenue to pay for it,” spokeswoman Logan Tucker said.

Supporters of Medicare for all point out the U.S. is already projected to spend nearly $60 trillion on health care over a decade. And while experts offer different cost projections, Medicare-for-all backers — including Titus — say it will ultimately not only save the nation trillions, but lower total health care costs for individuals and families.

A founding member of the Medicare for All congressional caucus, Titus is an original cosponsor of the House bill, which would cover primary, emergency and long-term care. That includes mental health, dental and vision care in addition to prevention services and dietary and nutritional therapies.

“While defending and improving the ACA should be our priority, Democrats like me are not afraid to dream big,” she wrote last year. “Medicare for all is a bold idea, but Congress must be bold to solve our nation’s health care crisis.”

Dominating the Democratic primary

Whether to build on the ACA – or to replace it with a “single payer” system – is a dominant question in the packed contest for the Democratic Party’s presidential nomination.

Sanders has made Medicare for all a cornerstone of his presidential campaign, and numerous other Democratic candidates – including Sens. Kamala Harris and Elizabeth Warren – have expressed support for the cause.

But former Vice President Joe Biden, the current frontrunner, has a different take.

“Obamacare is personal to me,” he says in a new ad. “When I see the president try to tear down [Obamacare], and others propose to replace it and start over, that’s personal to me too. We’ve got to build on what we did because every American deserves affordable health care.”

In addition to cost, critics cite concerns about quality in a government-run system, including the loss of access to certain benefits. That prospect has sparked concerns among organized labor, including the Culinary Union, which represents about 60,000 hospitality workers in Nevada.

Nevada lawmakers on both sides of the aisle share those concerns.

Medicare for all would take employer-provided health care away from more than half of the state’s population and force them into a single-payer system, Amodei’s spokeswoman said — a point Horsford recently echoed in an interview with the Nevada Independent.

Instead, Amodei supports the recent expansion of association health plans — coverage secured by groups of individuals and small businesses — and increasing transparency.

Horsford and other Democrats, meanwhile, are pushing for a “public option” that would allow people to choose Medicare instead of a private insurance plan — a proposal that was considered too radical by some Senate Democrats to be included in Obamacare when the legislation was being crafted a decade ago.

Democrats also back other reforms, such as barring surprise health care bills and reducing the cost of prescription drugs.

Though she backs Medicare for all, Titus isn’t under any illusions that it will become law soon. “With Donald Trump in the White House and Mitch McConnell controlling the Senate, the chances of passing Medicare for All are nil,” she said in a statement.

Still, she’s glad Democratic presidential candidates are emphasizing access to health care on the hustings.

“Whomever I support in 2020 will share my goal to expand quality, affordable health care, as opposed to Donald Trump, who has from Day 1, worked to limit access to health care for millions of the most vulnerable,” she said. Titus hasn’t endorsed a candidate yet, but she has said she intends to before Nevada Democrats caucus in February.

Medicare for all is not the only position where Titus finds herself standing out from the rest of the delegation. About half the Democratic members of the U.S. House have called for the House to launch an impeachment inquiry of Donald Trump. Titus is the only one from Nevada who has joined them.