As 2020 presidential hopefuls such as Sens. Kirsten Gillibrand of New York and Kamala Harris of California voice support for single-payer health care, the concept has slowly found backing in some unlikely places. That includes the 2018 congressional races in Texas, where more than half the Democratic candidates competing Tuesday in the primary runoff elections have endorsed single-payer.

As Politico reported Saturday, while the national party is “trying to minimize internal battles on health care, Democrats in this deep red state have also watched closely races where single-payer advocates have upset centrist primary opponents.”

This group includes Beto O’Rourke, who is challenging Ted Cruz for a Senate seat. Before his 2016 presidential bid, Cruz was most famous for his staunch opposition to the Affordable Care Act (ACA), even helping to shut down the government in a failed repeal attempt in 2013.

Rather than trying to win over centrist Democrats or moderate Republicans, candidates are attempting to appeal to progressive voters who might have opted out of voting altogether. As Wendy Davis, a Democrat and former Texas gubernatorial candidate, told Politico, “I’ve heard the analogy before that we aren’t trying to get people to convert from Catholicism to Baptism, but trying to get people who are Baptist to come to church.”

And this isn’t happening only in Texas.

Across the country, attacks on the ACA have neither helped Republicans win elections nor made incumbents secure for the midterms. Grass-roots energy helped pack town halls—even in such staunchly red states as Arkansas—with constituents demanding that their Republican legislators stop their attempts at ACA repeal. In Virginia, Democrat Ralph Northam won the governor’s race against Republican Ed Gillespie for multiple reasons, but his support for both the ACA and for expanding Medicaid in that state helped.

Texas Democrats don’t expect the state to turn blue overnight, but as Politico notes, “the state’s Democrats face a very different political climate in 2018,” partly because voters across the country have rejected Republican attempts to repeal the ACA.

Not content to simply defend existing law, many candidates are channeling their energy to campaign for single-payer. “Health care is one of our No. 1 issues this election,” Tariq Thowfeek, communications director for the Texas Democratic Party, told Politico. “Our platform is far more progressive” than the national Democratic Party’s.

Some candidates, such as Lizzie Fletcher, who is seeking a House seat, believe this plan goes too far. Fletcher is a supporter of the ACA but not of single-payer. She is facing a runoff in Houston against Laura Moser, who supports single-payer. Fletcher believes that “[t]his is a traditionally Republican district that doesn’t think government is the solution to everything.” Moser retorted, “I hate it when Democrats use Republican talking points.”

Whether the leftward pivot yields results at the Texas ballot box on Tuesday or in November, experts and candidates believe this is a crucial moment to build support for single-payer.

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