CLEVELAND, Ohio -- Nationally, "Medicare for All" is growing in popularity within the political left. But three politicians help illustrate a more halting level of current support among Ohio Democrats when it comes to universal, government-provided health insurance.
First, there's Rep. Tim Ryan. He represents a safe Democratic district that includes Youngstown and the surrounding area. He also has been working to build a national profile, booking appearances at events like the Iowa State Fair and the progressive Netroots Nation conference in Louisiana, generating buzz about what he might do in 2020.
Ryan loves Medicare for All. He says it would help businesses by introducing greater certainty into their budgeting for health insurance costs, while giving workers the peace of mind to take professional risks without fear of losing coverage. Concerns about program costs are misplaced, when taking into consideration the elimination of private health-insurance premiums, he said.
"Everybody's got to make their own [political] judgment on it," Ryan said. "My judgment is, when presented as a way to increase wages and jobs and private investment, it's a winner."
Then, there's Sen. Sherrod Brown. Brown is a longtime supporter of single-payer health insurance, a less flashy name for Medicare for All. But when Sen. Bernie Sanders last year introduced a Medicare for All bill, Brown didn't join other prominent Democrats in co-sponsoring it. Instead, he threw his support behind a more incremental plan that would allow people as young as 55 to buy their way into Medicare coverage, which normally kicks in at 65.
"Republicans want to take away consumer protections - that is the fight for me," Brown said when asked about the issue during a recent conference call. "I don't get into what's next. Medicare for All is a question for another day."
Brown also is running for statewide re-election just two years after Donald Trump won Ohio by 8 points. Wadsworth Rep. Jim Renacci, a Republican who's mounting an uphill battle to unseat Brown, has tried to exploit the issue to his political advantage, with little luck so far.
Finally, there's Franklin County Recorder Danny O'Connor. O'Connor nearly beat State Sen. Troy Balderson on Tuesday in a special election in a district that was designed to decisively elect a Republican. When asked about Medicare for All in the lead-up to Election Day, O'Connor pivoted away to describe his support for the Affordable Care Act, the 2010 federal health-care law also known as Obamacare.
"I think what we have right now is something that's worth protecting," he recently told The Guardian, a British newspaper. "I think there are small tweaks we can make."
In total, Ryan, Brown and O'Connor represent a common theme -- the more competitive the race, the less likely Democrats are to fully embrace an issue whose popularity in a moderate state like Ohio is unproven at best. Democrats running this year have been cautioned against running too far to the left on health care, getting encouragement from groups like the Democratic Congressional Campaign Committee to instead focus on protecting popular parts of the Affordable Care Act, such as coverage for pre-existing conditions.
As such, Ohio Democratic candidates running in more competitive races -- like Aftab Pureval, challenging Rep. Steve Chabot in Ohio's 1st District, Betsy Rader, challenging Rep. Dave Joyce in the 14th District and Susan Moran Palmer, running against former NFL player Anthony Gonzalez to fill Renacci's vacant seat in the 16th District -- in public statements have avoided endorsing Medicare for All.
"I agree with the goals of Medicare for All, but I have real doubts about its cost, and how long it could take to enact," Palmer, who works in the health-care industry, said in a statement. "I think our first priority needs to be stopping Congressional Republicans and the Trump Administration from driving up healthcare costs and abandoning millions of Americans with pre-existing conditions."
Meanwhile, Ryan and fellow Ohio Democratic Reps. Joyce Beatty and Marcia Fudge last month joined a new, informal "Medicare for All Caucus." Ohio's fourth Democratic representative, Rep. Marcy Kaptur, has signed a resolution endorsing Sanders' Medicare for All plan but hasn't joined the caucus yet. All represent safe Democratic seats.
Debbie Silverstein is the state director of the Single Payer Action Network of Ohio, which has been lobbying for universal public health insurance for more than a decade. She said thanks to Sanders' surprisingly competitive 2016 presidential run, support from Ohio Democrats for state-level single-payer bills is are at an all-time high. But some still shy away from it.
"I think in the mainstream, we're coming around to it...There's more of an acceptance by some of the politicians," Silverstein said. "For others, I think it's a fear of being too... Well, I had one tell me they thought doing it would hurt their credibility."
Ohio Democratic Party Chairman David Pepper said there's room within the party for different views on health-care policy.
"I think that Ohio voters are eager to hear from anyone who's got real plans on how to make things more affordable and accessible, and they're open to hearing the different arguments," Pepper said. Republicans, he said, have failed to improve the existing health-care system.
Ohio Republicans have been looking to draw a position on Medicare for All from Richard Cordray, the Democratic nominee for Ohio governor who's running against Republican state Attorney General Mike DeWine. While Medicare is a federal program, the Washington Post recently reported that "at least a dozen" Democratic governor candidates across the country were campaigning on setting up a single-payer system in their own states. (One such candidate, Abdul El-Sayed, placed second in Tuesday's Democratic gubernatorial primary in Michigan.)
"I support the health care law we have on the books today," Cordray said at a recent news conference at the Ohio Statehouse when asked for his position on Medicare for All. The Ohio Republican Party posted a video clip of the conference on YouTube, saying Cordray "dodged" the question.
Armed with polling, Ohio Republicans think pinning down Democrats like Cordray and Brown on Medicare for All will provide an opportunity to attack them on expanding the scope of government and raising taxes to pay for it. One study, released last week by a right-leaning Washington, D.C. think-tank, placed the costs for Sanders' national Medicare for All program at $32.6 trillion over 10 years.
"It's wildly unpopular. That's why we are focused on it," said Rob Secaur, executive director of the Ohio Republican Party. "It's a drastic expansion of the federal government. It's all of the bad parts of Obamacare extended to everybody."
Paying for the program would require at least doubling federal taxes, although there would be cost offsets on things like negotiated lower reimbursement rates for insurers and lower prescription-drug costs, the study found. It also projected that overall national health-care spending would decrease slightly, with costs being shifted from private payers to the government.
But Ryan, the Democratic congressman, said focusing on the top-line price tag is the wrong framing of the issue.
"You can't focus on the cost unless you also focus on the costs you're going to get rid of," Ryan said. "You're not going to be dealing with a health-care bill every month... so this is going to save money for the average family."