The major battleground-state Democrats running to flip the Senate want nothing to do with "Medicare for All."

In states like Arizona, Iowa and North Carolina, challengers Mark Kelly, Theresa Greenfield and Cal Cunningham are staying tightly focused on the health care message House Democrats used in 2018: expanding Medicaid, protecting Obamacare and slamming Republican repeal efforts. Incumbents like Sens. Jeanne Shaheen (D-N.H.), Doug Jones (D-Ala.) and Gary Peters (D-Mich.) are aligned similarly, backing proposals like a public health insurance option but declining to embrace a single national insurance plan.

It is a striking split between the Democrats making general election plans in key battleground states and presidential hopefuls like Sens. Bernie Sanders and Elizabeth Warren, who are confronting a national Democratic primary. And it could make for an awkward general election if either Warren or Sanders becomes the Democratic presidential nominee campaigning on Medicare for All, while the party’s likeliest swing-state Senate nominees run on more moderate health care platforms.

Asked in an interview if Medicare for All proponents could win his state, which is a critical battleground, Peters said they would “have to show and be able to explain exactly how that would help folks here in Michigan.

“I think people do want to have the opportunity to keep private insurance,” he added, noting that he supports a public option and legislation lowering the age requirements for Medicare.

Republican strategists are already working relentlessly to tie vulnerable Democratic incumbents to Medicare for All, whether or not they back the proposal. But activist groups fighting for single-payer health care argue the sweeping policy will energize the Democratic base, and that candidates who are too cautious and calculating won’t give voters a reason to turn out in 2020.

“These policies that sell themselves as safe and incremental do not move people,” said Kelly Coogan-Gehr, the assistant director of public and community advocacy for National Nurses United, the top labor union fighting for Medicare for All. “The grassroots is not moved by safety. We are talking to hundreds of people every day and they are not moved by expanding the ACA or a public option. They want something much more comprehensive and they’re willing to fight for it.”

Democrats need to gain at least three seats to win back the Senate in 2020. Recent polling indicates the party has a strong advantage on the issue of health care, but the general public remains wary of Medicare for All, and support for eliminating private insurance is low.

Democratic strategists say it makes sense that presidential candidates are duking it out over Medicare for All since they largely agree on their health care ideals and want to demonstrate bold ideas to eager Democratic voters. But some worry that risky promises for single-payer health care are taking priority over highlighting Trump’s deeply unpopular record.

“This election is a referendum on the incumbent president,” said Brad Woodhouse, a veteran Democratic consultant and executive director of the pro-Obamacare advocacy group Protect Our Care. “It’s a missed opportunity not to lay out the consequences of a second Trump term for American health care: another run at repeal, massive cuts to Medicare and Medicaid, constant efforts to shrink the Medicaid rolls and kick people off their coverage. That’s at least as important as laying out your plan for coverage.”

Woodhouse, a former spokesperson for the Democratic Senatorial Campaign Committee, said Democrats need to keep up the drumbeat about Republicans’ attempts to repeal Obamacare in 2017, as well as the lawsuit currently before a federal court that could completely eliminate the Affordable Care Act and throw tens of millions of people off their insurance. Trump’s Justice Department has backed the suit, which could go before the Supreme Court next year.

Sens. "Joni Ernst, Thom Tillis, Mitch McConnell, Cory Gardner — they haven’t faced the voters since they tried to repeal health care,” Woodhouse said. “And none of the most vulnerable Republicans running for reelection have separated themselves from the Texas lawsuit.”

The lawsuit has become a focal point for Democratic Senate campaigns, with candidates also touting their own work to defend and expand Obamacare.

In Arizona, Democrats flipped a Senate seat last year largely by focusing on health care, hitting Republican Martha McSally for voting in the House to repeal Obamacare. McSally, who was appointed to the Senate and is running again next year in a special election, is facing Kelly, who made clear in a recent interview with the Arizona Republic that he does not support Medicare for All.

“I think it takes us in the wrong direction, in the opposite direction from where we need to be going,” Kelly said, pointing to those who would lose private insurance under the plan and saying he prefers a public option. “That health insurance isn't always perfect but there are a lot of those individuals that like the plan that they have. I don't think we should take that away from them.”

Other top Democratic recruits have similar positions. In Iowa, DSCC-backed Greenfield supports a public option and shoring up Obamacare, according to a campaign aide. In North Carolina, Cunningham told local media after launching his campaign in June that he’s open to a public option but does not support eliminating private insurance. In Georgia, Teresa Tomlinson, the first Democrat in the race, backs a public option.

And in Colorado, which looks like Democrats’ best opportunity to flip a Senate seat in 2020, newly minted Democratic front-runner John Hickenlooper spent his brief presidential campaign as an outspoken Medicare for All skeptic. Most of the other contenders also back some sort of public health care options. But Andrew Romanoff, the only top candidate in the race backing Medicare for All, told POLITICO that some Democrats are “running scared” from Republican arguments against single-payer.

“It won’t pass unless we lead the fight for it, and a lot of Democrats are surrendering without the fight,” Romanoff said.

In Texas, Democrats are similarly split. Former Rep. Chris Bell and activist Cristina Tzintzun Ramirez favor Medicare for All. In a statement, Ramirez called it the “gold standard for ensuring that every American has comprehensive health care.” But two others, Amanda Edwards and MJ Hegar, back a public option.

“I didn't necessarily go in the direction of Medicare for All not because in principle we don't want the coverage, certainly we do,” Edwards said in an interview after launching her campaign in July. “I just think there are different ways to try to achieve the goals of expanded access to coverage and optionality people have expressed that they wanted.”

While Shaheen cosponsored an earlier version of Sanders' bill, she did not sign onto the 2019 legislation and has been running on a more moderate health care agenda of maintaining and expanding the current system.

"The best thing to do is build on the Affordable Care Act, address the parts of it that aren’t working," Shaheen said. "I think that’s the fastest way we’re going to expand coverage and we can lower costs at the same time."

Internal polling from July reviewed by strategists advising Democratic Senate campaigns showed the party maintained an advantage among swing voters on health care, including on lowering costs and public option proposals.

Stewart Boss, a spokesperson for the Democratic Senatorial Campaign Committee, said Democrats are “focused on proposals that would expand coverage, improve access to health care and bring down costs,” while Republican incumbents will be “held accountable for their harmful votes” repealing the Affordable Care Act.

Republicans have used single-payer as a wedge issue. The National Republican Senatorial Committee has paid for billboards highlighting the issue in Senate battlegrounds, and One Nation, a nonprofit affiliated with GOP leadership, has run TV ads attacking the policy.

“For Democrats, all roads lead to Medicare for All and the elimination of the employer-based coverage," said Jesse Hunt, a spokesperson for the NRSC. "Senate Democrats will not be able to escape the socialist agenda being promised by their party’s presidential candidates no matter how hard they try to obfuscate their true objective.”

Advocacy groups stumping for Medicare for All agree that a single-payer supporter winning the nomination will put enormous pressure on Senate candidates running in swing states — but they see this as a benefit rather than a liability.

“Up and down the ticket you will see them forced to respond to Medicare for All,” says Coogan-Gehr. “People will hold their feet to the fire like never before.”