The divide over health care among Democratic presidential candidates is raising fears the party might turn an issue that was a key winner in the House midterms into a liability in next year's Senate races.
Democratic Senate candidates have been planning to borrow heavily from the playbook used by House Democrats in 2018, when the party won back the chamber in large part because of a pledge to protect ObamaCare against Republican attempts to kill the 2010 law.
Democrats are attempting to replicate that success with a push to take the majority in the Senate during an election year when they will face a more favorable map than the midterms. Republicans must defend 22 seats compared to the 12 held by Democrats.
But worries are rising that the bitter dispute among White House hopefuls over the direction of health care will weigh on Democrats and give a boost to GOP incumbents.
Progressive presidential candidates like Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.) are backing an ambitious "Medicare for All" plan, while some centrists say the proposal is akin to repealing ObamaCare.
In doing so, strategists warn that moderates are using language that is essentially playing into the hands of President Trump and other Republicans.
“That kind of rhetoric is very, very harmful,” said Brad Bannon, a Democratic strategist. “It illustrates the divide in the party, and I think this whole debate is confusing people.”
Democrats are hoping to stay unified on health care in Colorado and Arizona, where they’re pushing to unseat vulnerable Republican senators by tying them to the Trump administration’s efforts to undo the Affordable Care Act (ACA).
In Colorado, a crowded field of Democrats is battling it out to determine who will challenge Sen. Cory Gardner (R), one of the most vulnerable GOP senators up for reelection next year in a state that has increasingly favored Democrats in statewide contests.
His potential challengers are hitting him on his record of voting to repeal ObamaCare and for not speaking out against an administration-backed lawsuit aimed at overturning the health care law.
But Gardner has deflected those efforts by highlighting the Medicare for All debate, mirroring language used by former Vice President Joe Biden, the front runner in the Democratic presidential primary who has compared Medicare for All to repealing ObamaCare.
“The Democrats want to repeal and replace ObamaCare with socialized medicine,” Gardner told The Hill. “This is a leap to the left as the Democrats in the state of Colorado and nationally try to out-socialism each other. I think voters are going to reject that.”
Single-payer has proven unpopular in Colorado. Voters in Colorado widely rejected a single-payer ballot initiative three years ago, 79 percent to 21 percent.
But most of Gardner’s challengers don’t support Medicare for All, which calls for eliminating private insurers.
Rachel Petri, a spokeswoman for former state Sen. Mike Johnston, one of the top fundraisers in the race, said Johnston “does not plan to take away private insurance for anybody.”
“He thinks that you can offer the public option while still allowing that flexibility for folks to keep their health care that they have if they like it,” Petri said. “At the end of the day, all of the Democratic presidential candidates and all of the Senate primary candidates here in Colorado support universal coverage, and they are unified on that. People have different paths to it.”
One area where Democrats are hoping to draw a bright line between themselves and Republicans is the Trump administration’s support for a lawsuit brought by a group of GOP-led states that argue ObamaCare is unconstitutional because Congress repealed the penalty for people without insurance.
The lawsuit, which is awaiting action in a federal appeals court, aims to overturn the Affordable Care Act (ACA) in its entirety.
Asked if he supported the lawsuit, Gardner replied: “That’s the court’s decision. If the Democrats want to stand for an unconstitutional law, I guess that’s their choice.”
Republicans, including Gardner, have said they will provide protections for people with pre-existing conditions if the courts overturn the ACA. But Democrats argue the GOP proposals fall short of the protections enshrined in the 2010 law.
In Arizona, where Sen. Martha McSally (R) is likely to face former astronaut Mark Kelly in November 2020, the National Republican Senatorial Committee paid for billboard ads earlier this year accusing Kelly of remaining “silent” as 3 million “Arizonans would lose their health insurance.”
After the ads went up, Kelly said he opposed Medicare for All.
"We should be able to provide access to affordable health care for everybody, but I am not in favor for the 156 million of us that get our health care through our employer to make that go away," he said in April.
Kelly instead supports a public option.
Republicans are likely to frame that approach as a gateway to Medicare for All.
“That would make it incredibly difficult for private insurance to compete, and it’s a fast track to what the ultimate goal is: Medicare for All,” a Republican strategist told The Hill.
The issue is likely to pop up in other competitive Senate races, like in Alabama, where Medicare for All opponent Sen. Doug Jones (D) is fighting to keep his seat in a red state.
The party’s division over health care has Senate Minority Leader Charles Schumer (D-N.Y.) focusing his party on an area of consensus: protecting ObamaCare.
Senate Democrats plan to force a floor vote on health care that would give Democrats another opportunity hit vulnerable Republicans like Gardner on pre-existing conditions protections.
“Republicans campaigned on protecting Americans with pre-existing conditions, but they’re silent when the Trump administration sues to undo the whole ACA,” Schumer told reporters last week, referring to the GOP lawsuit. “This vote will be a test.”
Republicans say they aren’t worried, arguing the debate has since shifted to Medicare for All.
“It’s going to be difficult for [Senate] Democrats to run on ObamaCare when the loudest voices in the party aren’t talking about it,” the Republican strategist said.
During last week’s Democratic presidential primary debates in Detroit, almost a full hour was dedicated to discussing and dissecting Medicare for All. Only two presidential candidates — Sens. Cory Booker (D-N.J.) and Kirsten Gillibrand (D-N.Y.) — briefly mentioned the ACA lawsuit.
The White House has also taken notice.
“We've noticed with some bit of delight and irony that the Democrats seem way past ObamaCare at this point,” White House senior counselor Kellyanne Conway told reporters Wednesday.
"They're all just marching toward socialized medicine, government-run health care, wrapped up with something called Medicare for All, which basically means less Medicare for seniors. So if they're not talking about ObamaCare, why should we be?"
The rift among White House contenders is frustrating some Senate Democrats.
“I understand the need for candidates in a competitive situation to not emphasize areas of agreement, but we still want to win a general election, and the most effective way to the general election was making absolutely crystal clear: Democrats are about protecting and expanding health care and Republicans are dedicated to taking it away,” said Sen. Brian Schatz(D-Hawaii).
Democrats argue voters aren’t likely to be distracted by the Medicare for All debate.
A Morning Consult poll conducted July 25–27 found that voters trust Democrats more than Republicans when it comes to health care by a 9 point margin.
The same poll found that health care is the third most important issue among registered voters who participate in general elections, and it’s the No. 1 issue for primary voters.
“We're hitting them on their voting records and they're grasping at straws trying to find some angle to push back on health care because they know they’re losing on the issue,” said Democratic Senatorial Campaign Committee spokesperson Stewart Boss.
“This is an area where Democrats have a clear and commanding advantage, and the Republican agenda to repeal the health care law and gut protections for pre-existing conditions remains toxic with voters across the country.”