The “Medicare for All” bill that presidential hopeful Sen. Bernie Sanders released Wednesday is more likely to be litigated on the campaign trail than in the halls of Congress. And it highlights a rare political divide among Democrats on one of their marquee issues even as the party seeks to appear unified.

Supporters of the Vermont independent are vying with Democrats who prefer to expand and protect the 2010 health care law. Those differences have recently been overshadowed by larger fights between the two parties after the Trump administration broadened its position in a high-profile lawsuit by calling to strike down the entire 2010 law.

But the Sanders bill may become a point of contention in 2020 primaries. It is likely to be the most progressive and one of the most talked-about health care plans on the campaign trail.

Flanked by New York Sen. Kirsten Gillibrand, a 2020 rival, Sanders compared the movement for Medicare for All to the civil rights and women’s movements, vowing that it would end the health care industry’s for-profit motives that he says some people pay for with their lives.

“What we are involved in is not just health care legislation. We are involved in a great struggle,” he said. “This is a struggle for the heart and soul of who we are as American people.”

From the archives: Single Payer vs. Medicare for All

Sanders acknowledged in a statement Wednesday that the bill does not have enough support to pass even through reconciliation, a budget procedure that allows the Senate to pass legislation with 51 votes. But he said elected officials and candidates “should do what grass-roots Democrats want them to do.”

He called for a return to the “talking filibuster,” and noted that the vice president can overrule the Senate parliamentarian to determine what can be passed through reconciliation.

“Once we have — and I believe it will be sooner than later — a Democratic majority who are prepared to vote for Medicare for All in the House and Senate, we will pass it,” he said. “I can tell you that a vice president in a Bernie Sanders administration will determine that Medicare for All can pass through the Senate under reconciliation.”

Republicans jumped on Sanders’ proposal, warning that it would cause millions of people to lose their employer-sponsored insurance and would raise taxes, possibilities that polling shows are unpopular among voters.

“Self-proclaimed socialist Senator Bernie Sanders is proposing a total government takeover of healthcare that would actually hurt seniors, eliminate private health insurance for 180 million Americans, and cripple our economy and future generations with unprecedented debt,” White House Press Secretary Sarah Huckabee Sanders said in a statement. “The Trump Administration is working on realistic solutions to provide Americans with the options and control they want, the affordability they need, the ease they expect, and the quality they deserve, rather than forcing a government takeover of the healthcare system.”

Republicans are eager to try to frame the 2020 health care conversation in terms of the Sanders proposal and tie candidates on all levels to positions that the GOP calls too liberal.

“Democrat Senate candidates can try to hide, but we will make certain voters understand that Democrats are lining up behind abolishing private insurance, ruining Medicare, restricting medical choices, raising taxes on hardworking families, and exploding the deficit to the tune of $32 trillion,” said Senate Leadership Fund President Steven Law, a former chief of staff to Senate Majority Leader Mitch McConnell who leads one of the key outside groups supporting the GOP majority.

But the Senate Democrats who are not making runs for the White House do not intend to let McConnell and the rest of the Senate Republican Conference use Medicare for All as a wedge.

“I don’t support … McConnell using the floor to score political points, so if he continues to try to use the floor of the Senate as just a place for gamesmanship, I’ll continue to vote ‘present,’” Connecticut Sen. Christopher S. Murphy said Wednesday. “I think the vast majority of us will, enough of us to send that unmistakable message to him that we’re not going to reward him.”

Among the Democratic presidential candidates, even some co-sponsors view the effective phaseout of private health insurance more of an aspirational goal than an immediate policy aim.

“Anybody who says those words, ‘Medicare for All,’ who’s running for president, the next thing out of their of mouth should be talking to people about, well … if we are a split Congress, what are you going to actually do in your first year to make health care more accessible and affordable?” New Jersey Sen. Cory Booker, who co-sponsored Sanders’ bill, said Wednesday.

Booker, speaking with WCBS Radio in New York, pointed to allowing Medicare to negotiate prescription drug prices as one of the immediate priorities.

“There’s a lot of very pragmatic things we can do. But yeah, when it comes to my ideals, if I was going to design the system, and where I think we should be moving as a country ultimately is towards Medicare for All,” he said.

To Booker’s point, Democrats are clearly divided on a single-payer system such as Medicare for All, with moderates raising concerns about the cost and efficiency of such a plan. Lawmakers have offered a handful of other ways to expand Medicare or Medicaid to reach universal coverage.

Even if Democrats take control of Congress in 2021, passing a single-payer health care bill would be a challenge. Party leaders haven’t signed on to single-payer bills, and Sanders actually has support from fewer senators this year than he did in 2017, with former Minnesota Sen. Al Franken no longer in office and New Hampshire Sen. Jeanne Shaheen, who is seeking re-election next year, opting to support other proposals.

Other options

In the House, fewer than half of the Democratic members support their chamber’s version of the bill. Presidential candidates Reps. Eric Swalwell of California and Tulsi Gabbard of Hawaii, co-sponsored it, along with 108 other Democrats. But many recently elected Democrats represent swing districts where voters may be skittish about government-run care.

Minnesota Sen. Amy Klobuchar, a White House hopeful who has not signed on to the Sanders bill, is seeking to focus on other, less-divisive issues. She’s the lead Democratic co-sponsor of a bill to let people import prescription drugs from Canada, alongside Senate Finance Chairman Charles E. Grassley of Iowa.

“I want to get to universal health care,” Klobuchar said. “I just think there’s a number of ways to get there, and I think the public option would be something you could get done immediately.”

So far, the differences between Democrats may not seem significant to voters. Larry Drake, the chairman of the Rockingham County Democratic Committee in New Hampshire, said few people are parsing the nuance between Democrats’ health care plans right now. People there are more interested in local issues, such as drinking-water quality and the opioid epidemic, he said.

“What all the Democratic candidates have in common is: Health care is a right and there should be universal coverage,” he said. “I cannot recall anybody saying, ‘Oh, I’m supporting this person versus this other person because of their health care plan.’”

Instead, Democrats are largely focused on which of the many candidates is best positioned to beat President Donald Trump. The differences between the Trump administration’s health care positions and all of the Democrats seeking the nomination are much starker than the differences among the Democrats.

Those differences became even more pronounced last month when the Department of Justice said it agreed with District Court Judge Reed O’Connor’s 2018 ruling that found that the entire 2010 health care law should be struck down now that there is no penalty for not having insurance coverage (which was struck by the tax overhaul signed into law in late 2017).

“People are legitimately concerned about the health care situation because of what the Trump administration has been doing and the fact that they have this lawsuit,” Drake said. “It’s kind of a luxury to debate different forms of universal coverage when you’re faced with actually losing whatever coverage you have.”