Democrat's 'Medicare for All' could be the signature 2020 debate

Pollsters say Americans remain 'on the fence'

By Grace Sparks, CNN
Win McNamee/Getty Images

Protesters supporting “Medicare for All” hold a rally outside PhRMA headquarters April 29, 2019, in Washington, DC. 

(CNN) - While "Medicare for all" quickly became one of the top policy issues of the 2020 race for the Democratic presidential nomination, polling doesn't show a clear preference for a government-run health care program over the current system.

Many Americans don't really understand Medicare for all, and when they do, they're on the fence about some key issues. But, that confusion is particularly significant when it comes to the 2020 primary as Democrats are torn about what their party's nominee should focus on, with some big ideological divisions throughout the party, that could be cause for in-party fighting.

"I think it will be a divisive issue in the primary," said Mollyann Brodie, senior vice president at the Kaiser Family Foundation. "Especially if people start hearing about and learning about what it might mean, there's an issue of disruption. [P]eople get really anxious when you start talking about changing their current health arrangements. ... All of a sudden you see this tendency for reversion to the status quo. So, I think that that is a challenge that many of the Democratic candidates are going to have to nuance and pay attention to in the primary."

Medicare for all was the among the first big issues that candidates worked to address in 2020, having already been a main topic of conversation for Sen. Bernie Sanders from 2016. Sen. Kamala Harris made waves at her CNN Town Hall in April when she said she supported the proposal, something that would entail the public getting rid of their private insurance (since then, her campaign advisers have said she would be open to letting private insurance stick around).

Other candidates have promised they wouldn't get rid of private health insurance, while some are going full speed ahead on Medicare for all.

During the next 10 months of Democratic campaigning, one of the top trends to watch will be how the public feels about Medicare for All as it gets more educated about the topic.

According to a Kaiser Family Foundation poll from January, most Americans don't actually know that Medicare for all would require them to get rid of private health insurance. More than half said they thought they would be able to keep their current health insurance, according to the poll.

Brodie presented the results on Tuesday and reported that the people who were in favor of Medicare for all were also the ones more likely to think they could keep their current insurance (67% of those who were in favor of Medicare for all).

Some proposed health care plans would allow Americans to keep their private insurance, but not the one with the official name of "Medicare for all." Kaiser has a handy tool on their site that breaks down the current public plan proposals, showing that the current Medicare for All Act of 2019, proposed in the Senate by Sanders and in the House by Rep. Pramila Jayapal, Democrat of Washington, wouldn't allow for private insurance companies.

And that could affect a lot of Americans. While 56% overall favored having a national health plan, sometimes called Medicare for all, that number went way down when asked if they would favor or oppose the plan if they heard that it would eliminate private health insurance companies (only 37% favored it, 58% opposed).

So while Democrats are arguing about Medicare for all, it may not even be what their party wants. Slightly more than half (52%) of Democrats and Democratic leaning independents said they think Democrats in Congress should focus their efforts on improving and protecting the 2010 Affordable Care Act over passing a national Medicare for all plan (39%), according to Kaiser's April poll.

Democrats and Democratic-leaning independents who identify as "liberal" were much more likely to prioritize their party's congressional leaders passing a Medicare for all plan than "moderate" Democrats and Democratic-leaning independents.

But there's still an appetite for improving the current system in the progressive wing of the party.

Liberal Democrats and Democratic-leaning independents tipped slightly towards improving the Affordable Care Act (49%) than passing Medicare for all (43%) while moderate Democrats and leaners were more solidly behind the ACA (62%) than Medicare (32%).

But even liberal Democrats want Congress to focus on protecting the ACA over passing Medicare, but just in lower numbers than their moderate counterparts.

Given all this debate and division, expect health care to be one of the biggest fights throughout the primary season, Brodie said.

"Historically, Democrats have always been the party of health care. And in 2016 and certainly 2018, the Democrats were really able to embrace health care again in a way that was really positive and engaging for their voters and likely helped enthusiasm to get people out to vote," Brodie said. "In terms of specifically this issue of Medicare for all and universal coverage, I think there are opportunities and challenges."

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