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It took only one question — the very first — in Tuesday night’s Democratic presidential primary debate to make it clear that the issue that united the party in last year’s congressional elections in many ways now divides it. When Jake Tapper of CNN asked Senator Bernie Sanders whether his Medicare for All health care plan was “bad policy” and “political suicide,” it set off a half-hour brawl that drew in almost every one of the 10 candidates on the stage. Suddenly, members of the party that had been all about protecting and expanding health care coverage were leveling accusations before a national audience at some of their own — in particular, that they wanted to take it away. “It used to be Republicans that wanted to repeal and replace,” Gov. Steve Bullock of Montana said in one of the more jolting statements on the subject. “Now many Democrats do as well.” (Goodnough, 7/30)

The targets Tuesday were two of the most liberal and leading candidates in the field, Sens. Elizabeth Warren (Mass.) and Bernie Sanders (Vt.), who were accused of embracing “free-everything . . . fairy tale” policies and making “impossible promises” that could compromise the party’s chances of winning back voters they lost in 2016 — a loss that cost them the White House. Warren and Sanders more than stood their ground during two spirited hours of sharp and passionate exchanges. (Balz, 7/31)

The most protracted exchanges of the night, and by far the most substantive ones, concerned Mr. Sanders’s signature proposal to replace private health insurance with a single-payer system of the kind employed in Canada and a number of European countries. Mr. Delaney and the other moderates attacked the proposal from the first minutes of the debate, calling it a politically toxic idea that would void the health care plans of union members and of employees of private businesses. “We don’t have to go around and be the party of subtraction, and telling half the country, who has private health insurance, that their health insurance is illegal,” Mr. Delaney said. (Burns and Martin, 7/30)

Warren added that Democrats aren’t trying to take away health care from Americans. “That’s what the Republicans are trying to do,” she said. “And we should stop using Republican talking points in order to talk with each other about how to best provide that health care.” (McCaskill, 7/30)

The battle lines were drawn in the first half-hour of the debate, as an impassioned and prolonged exchange broke out over whether to abolish private health insurance in favor of a single-payer system favored by Sanders and Warren. When Sanders was asked how he would respond to Delaney, who described Medicare-for-all as bad policy, the senator offered a blunt retort: “You’re wrong!” “Why do we got to be the party of taking something away from people?” Delaney asked him in return. “We don’t have to do that. We can give everyone health care and allow people to have choice.” Warren quickly jumped in, saying candidates who favor Medicare-for-all are not trying to take anything away from the American people. (Olorunnipa, Viser and Wang, 7/31)

Traditionally a noncombatant debater, Hickenlooper on Tuesday warned that Sanders’s policies would be a “disaster at the ballot box.” He continued: “You might as well FedEx the election to Donald Trump.” He added that he is more pragmatic about health care: “It comes down to that question of Americans being used to being able to make choices, to have the right to make a decision.” (Fuchs et al, 7/30)

Warren took a more measured, reasoned approach, while Sanders showed more outrage, throwing his hands up in disgust during one exchange with Hickenlooper. But the two never went after each other. At one point, when Sanders accidentally interrupted Warren, he stopped himself and apologized — a courtesy he didn't afford other opponents. (Taylor, 7/31)

“I don’t understand why anybody goes to all the trouble of running for president of the United States to talk about what we really can’t do and shouldn’t fight for,” Warren said after several candidates argued that she and Sanders would doom the party. Several of their opponents argued that there was too much at stake to risk giving any advantage to Trump and that a more pragmatic approach would sway a wider swath. (Bierman, Mehta and Halper, 7/30)

South Bend, Ind., Mayor Pete Buttigieg (D) said during the 2020 Democratic debate on Tuesday that Democrats should “stop worrying about what the Republicans will say” and stand up for “the right policy.” “It is time to stop worrying about what the Republicans will say,” Buttigieg said. “It's true that if we embrace a far-left agenda, they're gonna say we're a bunch of crazy socialists. If we embrace a conservative agenda, you know what they're gonna do?” “They're gonna say we're a bunch of crazy socialists. So let's just stand up for the right policy, go out there and defend it,” he continued. (Folley, 7/30)

Former Rep. Beto O'Rourke (D-Texas) said on Tuesday that it will take more than just expanding the Affordable Care Act to get Americans health insurance. "The middle class will not pay more in taxes to ensure that every American is guaranteed world-class health care. I think we're being offered a false choice," O'Rourke said at the Democratic primary debate in Detroit. (Manchester, 7/30)

Sanders has said that his single-payer plan would raise taxes on the middle class but that amount would be more than offset because people would no longer pay deductibles, co-payments or premiums for health insurance. Sanders has said one option to fund Medicare-for-all would be from a 4 percent tax on employees, exempting families earning less than $29,000. Warren appeared to join Sanders in making that argument under pressure from CNN’s Jake Tapper to answer whether she supports raising middle-class taxes to pay for the plan. ... But other candidates have sought to embrace proposals that are less expensive. (Stein, 7/31)

Moderate Rep. Tim Ryan (D., Ohio) said that Mr. Sanders didn’t know that benefits under Medicare for All would be as good as or better than private insurance. “I do know that. I wrote the damn bill,” Mr. Sanders responded. (McCormick and Parti, 7/30)

Estimates for Sanders’s Medicare for All plan project it would cost at least $30 trillion over a decade. To pay for those programs, candidates have focused on taxing corporations and the wealthy. But many of the plans they’ve put on the table would require across-the-board tax increases that would hit middle-earners as well as the wealthy. Some of the less ambitious plans that would preserve employer-based insurance -- like those Buttigieg and O’Rourke have said they support -- would likely cost less than Sanders’s proposal, but could still require middle-class tax increases, depending on their size. (Davison, 7/30)

“Tonight in America as we speak, 87 million Americans are uninsured or underinsured but the health-care industry made $100 billion in profits last year," said Sen. Bernie Sanders (I-Vt.). In the first part of his statement, Sanders is quoting from a 2019 report from the Commonwealth Fund. The report said that the number of people who are uninsured — 24 million — had declined since the passage of the Affordable Care Act in 2010, but that more people are “underinsured.” That term refers to out-of-pocket costs that exceed 10 percent of income (or 5 percent of income if low-income, as well as deductible that were more than 5 percent of income. It also covers people who may have had a gap in insurance coverage. The report said that 43.8 million people had insurance but were underinsured, while 19.3 million people had a coverage gap. (Kessler, Rizzo and Kelly, 7/30)

“Giant corporations and billionaires are going to pay more [under Sanders’s Medicare-for-all plan]. Middle class families are going to pay less out of pocket for their health care," said Sen. Elizabeth Warren (D-Mass.). This isn’t as straightforward as Warren makes it sound. Sanders has put out a menu of possible options for how to fund Medicare-for-all, though many experts says that he still falls short. One option would require a 7.5 percent payroll tax that employers would pay to help fund the program. Virtually every economist will tell you that a payroll tax paid by an employer largely comes out of the pay earned by the employee, but Sanders argues that the savings on the premiums currently paid by the employer should result in an overall reduction in costs for the employer. (Kelly, 7/30)

Kaiser Health News: In A Messy Democratic Presidential Debate, Facts About Medicare For All Get Tossed About 

Delaney: “It’s been well documented that if all the bills were paid at Medicare rate, which is specifically — I think it’s in section 1,200 of their bill — then many hospitals in this country would close. I’ve been going around rural America and I ask rural hospital administrators one question: ‘If all your bills were paid at the Medicare rate last year, what would happen?’ And they all look at me and say, ‘We would close.’” Delaney made this argument to attack Sanders’ Medicare for All plan, which he referred to as “bad” policy in his opening statement. He made this claim about rural hospitals during last month’s debates, too. We rated it False. (Huetteman, 7/31)

Lower-polling candidates did have their moments, though none outshone the top two. The self-help author Marianne Williamson got applause, and a huge surge of attention online, for her comments on racism and reparations. Mayor Pete Buttigieg of South Bend, Ind., drew a forceful contrast with President Trump. Gov. Steve Bullock of Montana, on the debate stage for the first time, made a case for himself as a voice of moderation. (Astor, 7/31)

Montana Gov. Steve Bullock, a centrist who was on the debate stage for the first time on Tuesday, was quick to mention that he was the only candidate in the race who had won a statewide election in a state that Trump won by 20 points in 2016. It was that record, he argued, that would propel him to victory in 2020. “I’m a pro-choice, pro-union populist Democrat that won three elections in a red state, not by compromising our values but by getting stuff done,” Bullock said. (Greenwood, 7/31)

Democratic presidential candidates took the stage for the first night of their second set of debates on Tuesday in Detroit. [Here] is a transcript that will be updated throughout the evening. (7/30)

A coalition of hospitals, insurance companies and drugmakers that oppose "Medicare for All" will air national television ads blasting the proposal during this week's Democratic primary debates. Partnership for America's Health Care Future, which is funded by influential health care groups like PhRMA, the American Hospital Association and the American Medical Association, will air the ads Tuesday and Wednesday nights as part of a six-figure television and digital campaign targeting the proposal and other expansions of Medicare. (Hellmann, 7/30)