Moreover, Democrats are not just focused on health care in general. They have a specific message that works: improving the Affordable Care Act.

A Third Way report found that health care proved to be far and away the most popular issue in Democratic ads in 2018. In swing districts, Democrats heavily leaned into protecting and expanding the Affordable Care Act — not promoting a single-payer system. In fact, more Democratic ads were run that explicitly opposed single-payer than supported it. Only two supported single-payer. These were run by Dana Balter in NY24 and by the Progressive Change Campaign Committee on behalf of Kara Eastman in NE02. Both of these candidates lost their races.

Sabato’s Crystal Ball confirmed these findings and issued a warning to Democratic presidential candidates to heed the results of 2018. Medicare for All is an issue best kept for safe districts, if at all. A diverse electorate does not support it. As the Kaiser Family Foundation points out in its Blue Wall Voices Project, Medicare for All turns off swing voters.