Trump: 'We're the party of health care.' Dems: We're the party of more Obamacare, not less.

WASHINGTON — Obamacare repeal versus Obamacare repair: That's where the next presidential election is heading.

On the Republican side, President Donald Trump approved a surprise decision to push for the complete elimination of the Affordable Care Act in the courts. If it succeeded, millions of Americans would lose private insurance or Medicaid coverage and the health care system would be thrown into chaos.

At the same time, Democratic House leaders introduced a bill on Tuesday to expand the ACA's benefits and tweak some features. And on the 2020 presidential trail, the party's candidates appear to be converging on a plan to offer a public option to consumers that competes with existing private plans.

Trump tweeted that the GOP will be "the party of health care," but Republican senators who met with him said the president offered few details on what their policy would look like if Obamacare were struck down.

In fact, there was little sign of outward enthusiasm for Trump's latest move among elected Republicans. The party paid a steep price for repeal efforts in the 2018 midterms — voters named health care their top issue in exit polls, and 75 percent of those who did supported Democrats.

Looking to move past that, the GOP shifted to a new message in recent months. Rather than framing the 2020 race as a choice between keeping Obamacare or repealing it, they began positioning the contest as a choice between government-run health care vs. the status quo.

Led by Trump, Republican lawmakers warned that the Democrats' Medicare For All plan was a "socialist" policy that was too risky, disruptive and expensive.

They eagerly honed in on Democrats' support for a bill by Sen. Bernie Sanders, I-Vt., that would provide all Americans with a more generous version of Medicare, effectively eliminating private insurance in the process. Several 2020 contenders, including Sens. Elizabeth Warren, Cory Booker, Kirsten Gillibrand and Kamala Harris had signed on as co-sponsors, while Beto O'Rourke appeared to endorse it during his Senate run, but backed off more recently on the presidential campaign trail.

There are signs that the Republican attacks have produced some results, even as Trump's decision ensures that repeal will likely be a leading message in 2020.

Support for Medicare For All has dropped in some polls. A Quinnipiac University survey on Tuesday found 43 percent considered single-payer a "good idea" compared with 45 percent who said it was a "bad idea." That's a decline in popularity from August 2017, shortly before Sanders introduced his bill, when there was 51 percent-38 percent net support for the plan.

Single-payer advocates believe they can build up support with the right public relations approach.

"A policy that covers everyone and eliminates out-of-pocket spending...will be an incredibly popular program, but do we need to do more educating the public? Unquestionably," said Adam Gaffney, president of Physicians for a National Health Program.

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WASHINGTON, DC - MAY 04: Republican House members join U.S. President Donald Trump on stage as he speaks during a Rose Garden event May 4, 2017 at the White House in Washington, DC. The House has passed the American Health Care Act that will replace the Obama era� Affordable Healthcare Act with a vote of 217-213. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - MAY 04: U.S. Sen. Bernie Sanders (I-VT) speaks during a Stop 'Trumpcare' rally May 4, 2017 in front of the Capitol in Washington, DC. Congressional Democrats joined activists for a rally to urge not to replace Obamacare, also known as the Affordable Care Act. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - MAY 04: U.S. Senate Minority Leader Sen. Charles Schumer (D-NY) (R) greets House Minority Leader Rep. Nancy Pelosi (D-CA) (L) during a Stop 'Trumpcare' rally May 4, 2017 in front of the Capitol in Washington, DC. Congressional Democrats joined activists for a rally to urge not to replace Obamacare, also known as the Affordable Care Act. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - MAY 04: U.S. President Donald Trump shares a moment with Speaker of the House Rep. Paul Ryan (R-WI) during a Rose Garden event May 4, 2017 at the White House in Washington, DC. The House has passed the American Health Care Act that will replace the Obama era� Affordable Healthcare Act with a vote of 217-213. (Photo by Alex Wong/Getty Images)
WASHINGTON, DC - MAY 04: U.S. House Minority Leader Rep. Nancy Pelosi (D-CA) (L) gestures as Sen. Patty Murray (D-WA) and Sen. Bernie Sanders (I-VT) wait for their turns to speak during a Stop 'Trumpcare' rally May 4, 2017 in front of the Capitol in Washington, DC. Congressional Democrats joined activists for a rally to urge not to replace Obamacare, also known as the Affordable Care Act. (Photo by Alex Wong/Getty Images)
UNITED STATES - MAY 4: Charlie Wood, 4, of Charlottesville, Va., plays with bubbles during rally on the East Front lawn of the Capitol to oppose the House Republicans' bill to repeal and replace the Affordable Care Act on May 4, 2017. She was born 3 1/2 months earlier and her mother Rebecca, at left, holding a picture of Charlie in the hospital, fears changes to the ACA will negatively effect her care. (Photo By Tom Williams/CQ Roll Call)
Health and Human Services Secretary Tom Price speaks in the Rose Garden of the White House following the House of Representative vote on the health care bill on May 4, 2017 in Washington, DC. Following weeks of in-party feuding and mounting pressure from the White House, lawmakers voted 217 to 213 to pass a bill dismantling much of Barack Obama's Affordable Care Act and allowing US states to opt out of many of the law's key health benefit guarantees / AFP PHOTO / Mandel NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
Ivanka Trump and Jared Kushner listen to US President Donald Trump speak in the Rose Garden of the White House following the House of Representative vote on the health care bill on May 4, 2017 in Washington, D Following weeks of in-party feuding and mounting pressure from the White House, lawmakers voted 217 to 213 to pass a bill dismantling much of Barack Obama's Affordable Care Act and allowing US states to opt out of many of the law's key health benefit guarantees / AFP PHOTO / Mandel NGAN (Photo credit should read MANDEL NGAN/AFP/Getty Images)
UNITED STATES - MARCH 9: Speaker of the House Paul Ryan, R-Wis., conducts a presentation in the House studio of the American Health Care Act, the GOP's plan to repeal and replace the Affordable Care Act, March 9, 2017. (Photo By Tom Williams/CQ Roll Call)
WASHINGTON, DC - MARCH 07: U.S. Secretary of Health and Human Services Tom Price compares a copy of the Affordable Care Act (R) and a copy of the new House Republican health care bill (L) during the White House daily press briefing March 7, 2017 at the White House in Washington, DC. Secretary Price answered questions on the new healthcare bill during the briefing. (Photo by Alex Wong/Getty Images)
U.S. Speaker of the House Paul Ryan speaks to the media about the American Health Care Act at the Capitol in Washington, D.C., U.S. March 15, 2017. REUTERS/Aaron P. Bernstein
WASHINGTON, DC - MARCH 13: U.S. Health and Human Services Secretary Tom Price (L) and Office of Management and Budget Director Mick Mulvaney talk to reporters following the release of the Congressional Budget Office report on the proposed American Health Care Act outside the White House West Wing March 13, 2017 in Washington, DC. Price said 'We disagree strenuously' with the findings of the CBO report about the Republican's attempt to repeal and replace the Affordable Care Act, or Obamacare. (Photo by Chip Somodevilla/Getty Images)
Speaker of the House Paul Ryan speaks at a news conference about Congressional efforts to repeal and replace Obamacare, on Capitol Hill in Washington, U.S. March 9, 2017. REUTERS/Aaron P. Bernstein
WASHINGTON, DC - MARCH 10: U.S. Vice President Mike Pence (4th L) delivers remarks at the beginning of a meeting with representatives of conservative political organizations to discuss the American Health Care Act in the Indian Treaty Room in the Eisenhower Executive Office Building March 10, 2017 in Washington, DC. Pence and Health and Human Services Secretary Tom Price led the meeting that included representatives from the Cato Institute, Tea Party Patriots, the American Conservative Union, Freedom Works, the American Legislative Exchange Council and other conservative groups. (Photo by Chip Somodevilla/Getty Images)
U.S. Speaker of the House Paul Ryan speaks to the media about the American Health Care Act at the Capitol in Washington, D.C., U.S. March 15, 2017. REUTERS/Aaron P. Bernstein
WASHINGTON, DC - MARCH 10: (L-R) U.S. Vice President Mike Pence and President Donald Trump greet House of Representatives committee leaders (L-R) House Budget Committee Chairwoman Diane Black (R-TN), Energy and Commerce Committee Chairman Greg Walden (R-WA) and Education and Workforce Committee Chairwoman Virginia Foxx (R-NC) before a meeting to discuss the American Health Care Act in the Roosevelt Room at the White House March 10, 2017 in Washington, DC. The proposed legislation is the Republican attempt to repeal and replace Obamacare. (Photo by Chip Somodevilla/Getty Images)
U.S. Speaker of the House Paul Ryan speaks to the media about the American Health Care Act at the Capitol in Washington, D.C., U.S. March 15, 2017. REUTERS/Aaron P. Bernstein
U.S. Health and Human Services Secretary Tom Price speaks about efforts to repeal and replace Obamacare and the advancement of the American Health Care Act on Capitol Hill in Washington, U.S., March 17, 2017. REUTERS/Joshua Roberts
A copy of Obamacare repeal and replace recommendations (L) produced by Republicans in the U.S. House of Representatives sit next to a copy of the Affordable Care Act known as Obamacare as U.S. Health and Human Services Secretary Tom Price addresses the daily press briefing at the White House in Washington, U.S. March 7, 2017. REUTERS/Carlos Barria
(L-R) U.S. House Speaker Paul Ryan, U.S. House Majority Leader Kevin McCarthy, and U.S. Representative Greg Walden hold a news conference on the American Health Care Act on Capitol Hill in Washington, U.S. March 7, 2017. REUTERS/Eric Thayer
UNITED STATES - MARCH 14: House Minority Leader Nancy Pelosi, D-Calif., and Senate Minority Leader Charles Schumer, D-N.Y., attend a news conference in the Capitol Visitor Center to voice opposition to House Republican's health care plan, the American Health Care Act, March 14, 2017. The event featured testimony from patients and doctors who benefit from the Affordable Care Act. (Photo By Tom Williams/CQ Roll Call)
UNITED STATES - MARCH 14: From left, Dr. Alice T. Chen, Senate Minority Leader Charles Schumer, D-N.Y., Sen. Maggie Hassn, D-N.H., and House Minority Leader Nancy Pelosi, D-Calif., attend a news conference in the Capitol Visitor Center to voice opposition to House Republican's health care plan, the American Health Care Act, March 14, 2017. The event featured testimony from patients and doctors who benefit from the Affordable Care Act. (Photo By Tom Williams/CQ Roll Call)
Speaker of the House Paul Ryan speaks at a news conference about Congressional efforts to repeal and replace Obamacare, on Capitol Hill in Washington, U.S. March 9, 2017. REUTERS/Aaron P. Bernstein
WASHINGTON, DC - MARCH 08: House Energy and Commerce Committee staff members work during a markup hearing on the proposed American Health Care Act, the Republican attempt to repeal and replace Obamacare, in the Rayburn House Office Building on Capitol Hill March 8, 2017 in Washington, DC. House Republicans were rushing the legislation through the powerful Energy and Commerce, and Ways and Means committees, aiming for a full House vote next week. (Photo by Chip Somodevilla/Getty Images)
WASHINGTON, DC - MARCH 07: House Energy and Commerce Chairman Greg Walden (R-OR) (R) and House Ways and Means Chairman Kevin Brady (R-TX) (L) arrive for a news conference on the newly announced American Health Care Act at the U.S. Capitol March 7, 2017 in Washington, DC. House Republicans yesterday released details on their plan to replace the Affordable Care Act, or Obamacare, with a more conservative agenda that includes individual tax credits and grants for states replacing federal insurance subsidies. (Photo by Win McNamee/Getty Images)
White House Press Secretary Sean Spicer (L) looks on as US Secretary of Health and Human Service Tom Price (R) points to a print-out of the Affordable Care Act (ACA) and a copy of the new plan introduced to repeal and replace the ACA during the daily briefing at the White House in Washington, DC on March 7, 2017. / AFP PHOTO / JIM WATSON (Photo credit should read JIM WATSON/AFP/Getty Images)
WASHINGTON, DC - MARCH 07: House Ways and Means Chairman Kevin Brady (R-TX) (L) and House Energy and Commerce Chairman Greg Walden (R-OR) (R) answer questions during a news conference on the newly announced American Health Care Act at the U.S. Capitol March 7, 2017 in Washington, DC. House Republicans yesterday released details on their plan to replace the Affordable Care Act, or Obamacare, with a more conservative agenda that includes individual tax credits and grants for states replacing federal insurance subsidies. (Photo by Win McNamee/Getty Images)
UNITED STATES - MAY 4: Protesters yell 'shame'' to members of Congress on the East Front of the Capitol after the House passed the Republicans' bill to repeal and replace the Affordable Care Act on May 4, 2017. The protesters support the ACA. (Photo By Tom Williams/CQ Roll Call)
WASHINGTON, DC - MAY 04: U.S. Sen. Bernie Sanders (I-VT) speaks during a Stop 'Trumpcare' rally May 4, 2017 in front of the Capitol in Washington, DC. Congressional Democrats joined activists for a rally to urge not to replace Obamacare, also known as the Affordable Care Act. (Photo by Alex Wong/Getty Images)
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But even before the latest survey, many Democratic candidates were subtly shifting their own message away from single-payer and toward more gradual approaches that build on Obamacare's existing structure.

In January, Harris told a CNN town hall that Americans that she favored replacing private plans with a single-payer program while House progressives released a new single-payer bill the next month — but few presidential contenders have followed their lead.

Instead, they've pivoted to arguments that Americans should have the option to purchase a public plan like Medicaid or Medicare, not have it forced on them.

O'Rourke, who expressed support for the Sanders bill as a Senate candidate last year, said this month that he had rethought his position and is interested in legislation that would let individuals buy into a public plan if they want. "It allows people to keep employer-based insurance, many of whom want to do that," he said.

Several Democratic presidential candidates who co-sponsored Sanders' Medicare For All bill have made the case — without explicitly abandoning support for single-payer — that a public option would eventually achieve the same goal as the legislation. Gillibrand, for example, touted a Medicare buy-in that caps premiums at 4 or 5 percent of income as "the quickest way to get" to single-payer, since she predicted customers would voluntarily decide to enroll in it over private insurance.

The same Quinnipiac poll that found support for single-payer waning found strong backing for an optional Medicare buy-in, with 51 percent calling it a "good idea" compared with 30 percent who said it's a "bad idea." Some polls also have found confusion among voters, many of whom thought a public option is what "Medicare For All" meant in the first place.

"I believe people want more healthcare and most are relatively open minded about how to achieve that," Sen. Brian Schatz, D-Hawaii, who authored a bill that would create a buy-in option for state Medicaid plans, told NBC News.

Single-payer will still be front and center if Sanders wins the nomination or activists can nudge wayward Democrats back toward his plan.

But for now, both parties seem to be settling into simple dueling health care messages for 2020: "Build on Obamacare with a public option," for Democrats and "repeal Obamacare first, then we'll talk," for Trump and the GOP.

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