Presidential candidate Elizabeth Warren speaks at a town hall meeting at Waterfront Park in San Diego on October 3, 2019.

Presidential candidate Elizabeth Warren speaks at a town hall meeting at Waterfront Park in San Diego on October 3, 2019. (K.C. Alfred/San Diego Union-Tribune/TNS)

WASHINGTON - Sen. Elizabeth Warren's colleagues aren't exactly jumping to voice support for her plan to finance "Medicare for All."

The hesitation from rank-and-file Democrats across the political spectrum on backing the Massachusetts Democrat's plan shows how fraught the issue is within the party – and how challenging it would be for a Democratic White House to shepherd a plan through Congress.

Just 14 senators, including Warren, have co-sponsored Medicare for All legislation from Sen. Bernie Sanders, I-Vermont, another White House hopeful, while half of House Democrats back a similar measure. The bills do not include provisions to finance the system, but Warren's proposal, which she spelled out under pressure from more moderate presidential candidates, did not appear to win over additional senators.

"Assuming Democrats control the Senate, I think that we would look to build on the Affordable Care Act so you would not have to deal with the financing that Sen. Warren's proposed," said Sen. Benjamin L. Cardin, D-Maryland, referring to the 2010 health care law. Cardin has not signed on to the Sanders legislation.

"There are different ways to get at this issue," said Sen. Mark Warner, D-Virginia, adding that he did not think eliminating private insurance under a single-payer plan would be the right approach.

Speaking to reporters in Iowa on Friday, Warren said she was confident Medicare for All could earn support in Congress.

"Yes, I believe in democracy. I believe that when we dream big and fight hard, we win," she said.

History shows that Warren or Sanders would likely need new members of Congress who campaigned on Medicare for All to be elected alongside them for the best shot of getting a single-payer policy through Congress, said Robert Blendon, a Harvard University professor of public health and health politics.

"If a House member didn't run on it and they're in some sort of mixed district, they're not going to be convinced by a president saying, 'I won, so therefore you have to do it,'" Blendon said.

Medicare for All has been a controversial topic within the party since after the 2016 election, when it became somewhat of a litmus test among progressives. Many Democratic lawmakers say they would prefer to build on the 2010 law, President Barack Obama's signature domestic policy.

An October poll from the Kaiser Family Foundation found that support for Medicare for All has narrowed in recent months, while support surged for a public option that would let people buy into a government health plan that would compete with private insurance plans.

Democrats have maintained an advantage over Republicans on health care issues, which remain a top issue for voters, according to a poll released Wednesday by Protect Our Care, a group that supports the 2010 law. The debate on Medicare for All hasn't changed that dynamic, said Geoff Garin, president of Hart Research, who conducted the poll.

"There's no evidence that as of today it's done anything that's harmful and the Democratic advantage is still as great as it was on the eve of the 2018 election," said Garin.

A poll set to be released next week by the Progressive Change Institute, the liberal consumer advocacy group Public Citizen and Business for Medicare for All will show that support for Medicare for All starts high. The poll, conducted by the consulting firm GBAO Strategies, found that 66% of voters support the policy and 34% oppose it.

When people are informed about negative attacks on the policy, support remains high, with 58% supportive and 42% opposed, according to data shared with CQ Roll Call.

Just months away from the first votes being cast in the presidential primary, Medicare for All is one of the starkest differences between the primary candidates.

But several Democratic senators this week said the candidate should focus more on their differences with President Donald Trump, taking cues from party strategists who are eager for candidates to do so.

Some candidates have sought to redirect the conversation to those differences during the primary debates, but the top-tier candidates have sparred over Medicare for All, keeping the health care discussion squarely focused on their differences.

"The good news is all Dems want to expand health care and all Republicans want to take it away," said Virginia Sen. Tim Kaine. "So depending on how many Dems we have, we will all be looking to expand and lower costs."'

Sen. Sherrod Brown, D-Ohio, a progressive who has recently warned against having a presidential nominee who supports Medicare for All, said Democratic presidential candidates should play up those differences instead of debating different ways to reach universal coverage. He referenced a lawsuit, Texas v. Azar, which the Trump administration has backed to overturn the 2010 health care law.

"Trump will take their insurance away if he wins that court case," Brown said.

Republican state attorneys general sued to overturn the law after Republicans essentially repealed a penalty for the law's requirement that most Americans have insurance coverage. While Republicans on Capitol Hill don't all support the lawsuit, there's not a consensus plan to restore popular parts of the law, like protections for people with pre-existing conditions, should the courts strike it down, but many Republicans have said they would like to protect pre-existing condition protections.

Even some lawmakers who have backed the Medicare for All bill said that Democrats should be highlighting the differences between themselves and Trump - which will likely become easier to do after the primary phase of the campaign.

Wisconsin Democratic Sen. Tammy Baldwin, a co-sponsor of Sanders' bill, said an expected ruling from the U.S. Court of Appeals for the 5th Circuit on the Texas v. Azar lawsuit may draw more attention to those differences.

"The difference in my mind is not among the Democratic contenders," she said. "It's between a president who's suing in court to take away 20 million peoples' health insurance and candidates who through a variety of plans are trying to extend access, lower prices and improve quality."

Visit CQ Roll Call at www.rollcall.com

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