WASHINGTON – Democratic politicians and candidates campaigning this year on protecting the Affordable Care Act are facing pressure from members of their own party who want them to go even further to get behind single-payer health care.

The push to implement what supporters have dubbed "Medicare for All," which counts U.S. Rep. Keith Ellison of Minnesota as a high-profile backer, threatens to divide the party as Democrats try to win control of Congress in the midterm elections and build a more cohesive policy platform that goes beyond opposition to President Donald Trump.

Ellison was among more than 60 House members who launched a Medicare for All caucus last week in Washington, a sign the policy is gaining momentum in Democratic ranks. At a single-payer conference last month, Ellison raised the idea that fellow Democrats who don't get on board should pay a political price.

"We need to run ads pointing out to constituents people who are not on the bill," Ellison said at the conference. He added: "Now, some of you are thinking, 'Oh Keith, how could you do that? This is wrong, this is not right, you're putting too much pressure on them.' Well let me just tell you this: If you're not ready to take the heat, you shouldn't be in the kitchen."

Opposing a 'litmus test'

Some of Ellison's fellow DFLers are not on board. That's prompted groups like the National Republican Campaign Committee (NRCC) to highlight the disagreement, with a particular focus on DFL candidate Angie Craig. She is challenging Rep. Jason Lewis in Minnesota's Second Congressional District.

Craig, who declined an interview for this story, has previously said she wants to move toward universal health care, along with enacting a permanent federal reinsurance program. But she has stopped short of backing Medicare for All and is not the only Minnesota Democrat to do so.

Craig "won't get behind their newest litmus test, single-payer," the NRCC said in a news release this month. "And to top it off she has to worry about her good friend Keith Ellison running ads against her!"

Ellison also declined an interview for this story. Ellison's fellow Minnesota Democrat, Rep. Betty McCollum, criticized his comments to the Star Tribune.

"Democrats believe health care is a right, but Medicare for All has no chance of becoming law with a Republican Congress and [Donald] Trump in the White House," McCollum said in a statement. "Mr. Ellison's rhetorical attack on Democrats fighting to gain control of the U.S. House is extremely disappointing, especially since he's quitting Congress and abandoning his own legislative effort."

Ellison is running for Minnesota attorney general. McCollum said her own immediate priority is protecting the millions of Americans with pre-existing conditions "who will lose their ACA protections if Republicans completely succeed in sabotaging our health care system."

In Minnesota's Third District, DFL challenger Dean Phillips said he backs "Medicare Extra," a proposal that would work toward universal coverage but keep a role for employer coverage and the health insurance industry, and thinks Medicare should be available for all as a buy-in. Phillips is running against U.S. Rep. Erik Paulsen, a Republican who repeatedly voted to dismantle the Affordable Care Act.

"I really believe in affordable choices for people," Phillips said. "I support Medicare for All as an option and health care for all."

Phillips said Ellison is entitled to his opinion, but he doesn't think other Democratic candidates should be pressured to support Medicare for All.

"I don't think there should be a litmus test," he said, adding that he wants to work with other policymakers with different viewpoints to fix the Affordable Care Act.

U.S. Sen. Amy Klobuchar hasn't come out in favor of the legislation. U.S. Sen. Al Franken was an early supporter of Medicare for All before he resigned. His successor, Sen. Tina Smith, said she supports a single-payer system but did not specifically back Medicare for All.

At a rally with Ellison and U.S. Sen. Bernie Sanders last week, Smith said, "I am so excited to be fighting with Bernie in the United States Senate for a $15-an-hour minimum wage, for paid family leave and for health care for all of us."

In a statement, Smith's office said she "believes a single-payer system is the best way to make sure all Americans can access affordable health coverage with good benefits for themselves and their families. With that goal in mind, she is supporting legislation that would allow people to buy into Medicare."

Support on Iron Range

In northeastern Minnesota, Medicare for All hasn't been a divisive issue: The four Democratic candidates in the August primary in the Eighth Congressional District all back the proposal.

"As a last resort I would vote for something more incremental," said Joe Radinovich, one of the candidates. "At the end of the day I'm not going to refuse to vote for something that represents 75 percent of the solution if it's going to benefit working people."

In the First Congressional District, the campaign of Democratic candidate Dan Feehan has voiced support for affordable, universal health care without supporting Medicare for All.

"If you are a candidate and you say you care about the massive inequalities in our country, then you have no choice but to support Medicare for All. And if you're unwilling to support Medicare for All, then I think it's more of a talking point than a change you actually want to make," said Dan McGrath, executive director of TakeAction Minnesota, which advocates for universal health care.

"A Democrat that wants to be successful this fall has to speak from a place of clear values and bold solutions if they're going to be effective," McGrath said. "This is part of the lesson of 2016 — people do not want small solutions to the massive problems we face."

Staff writer Kelly Smith contributed to this report. Maya Rao • 202-662-7433