AS MASSACHUSETTS Sen. Senator Elizabeth Warren joins Joe Biden atop the Democratic primary field, her rivals have sharpened their attacks on her positions, most notably around her support for Senator Bernie Sanders’s “Medicare for All” proposal. Today, Warren doubled down, releasing a massively complex and detailed plan to pay for her $20.5 trillion extension of federal health insurance to all Americans.

But as Warren lashes herself ever more tightly to Medicare for All, a new WBUR poll of voters in her home state of Massachusetts suggests possible trouble ahead. Just over half (54 percent) of Massachusetts registered voters support Medicare for All while 41 percent are opposed. By contrast, voters support a public option, or “Medicare for all who want it” by a 71 percent to 23 percent margin. When those two ideas were pitted against one another (alongside maintaining the status quo and repealing the Affordable Care Act), twice as many voters chose the public option over Medicare for all (43 percent to 22 percent). 

Medicare for All is somewhat more popular with likely Democratic presidential primary voters, but still trails the public option. Two-thirds (65 percent) of likely primary voters say they would support Medicare for All, while fully 83 percent say the same of a public option. Head-to-head, the margin in favor of the public option is only slightly smaller (44 percent to 28 percent) than among all voters.

To be clear, there’s a lot of good news for Warren in this poll. Her favorables with Democratic primary voters are sparkling, and she has taken a wide lead over the rest of the field, with 33 percent support to Joe Biden’s 18 percent. 

Even so, with support for her health plan barely over half even in deep blue Massachusetts, the political risk is real. The details of the poll identify another risk: The strongest supporters are also the youngest, with 65 percent of voters under 30 in favor of Medicare for All. Among older voters, who tend to turn out in the highest numbers, support for Medicare for All declines further. Voters over 65 are split with 47 percent supporting and opposing the plan. 

Voters are also unsure about the distinguishing feature of the plan. On the debate stage, Warren and Sanders have defended Medicare for All by attacking what it would seek to do away with: private insurance companies and their premiums and deductible. But only 29 percent of supporters of Medicare for All say that “getting rid of private insurance companies” is a very important impact of the policy. Far more cite lowering health costs (79 percent), covering all Americans (91 percent), and “being able to get care without worrying about the costs” (83 percent) as very important impacts of Medicare for All. 

Voters may also just not want to get rid of their own insurance; 91 percent of voters are satisfied with their current insurance, including 52 percent who are very satisfied. A poll from earlier this year found voters in the state are concerned about the costs and complexities of insurance, but do not seem to be ready to leap into the unknown. At a time when seemingly everything in politics is a pitched battle, voters, even in liberal Massachusetts, seem not to want to pick a fight on health care. 

Both policies are popular enough with Democratic primary voters to offer a path to victory, even though the public option is more popular. One caution is that in a year when Democrats are focused on finding a sure winner, many voters seem to be looking at candidates through a series of funhouse mirrors, trying to figure out what general election voters in other states might be looking at rather than only evaluating their own feelings. So the perception of being too liberal could have a weird, second order impact. 

How Medicare for All fares in a general election will depend on two key things. The first is the alternatives Republicans offer. Congressional Republican attempts to repeal the Affordable Care Act since Trump took office were deeply unpopular and only galvanized support for a once-unpopular law. National polling from the Kaiser Family Foundation has found that three-quarters of Americans want the government to do more, not less, to provide health insurance to Americans. 

Second, it’s very possible that health care will not play as central a role in 2020 as it did in the 2018 midterms. Then, Democrats won a landslide victory largely focusing on the issue and not on the president. This time, Trump will be on the ballot (barring removal from office) and judging by the current news environment, the contest appears set to take place in an open air circus. Policy disagreements seem like to draw far less attention than the near hourly sideshows. Both could take the heat off what could otherwise be a fairly tepid evaluation of Warren’s proposal from general election voters. 

Still, Democrats seem not to be in the mood to take chances, and Warren is taking a pretty big one committing to Medicare for All. Democrats are open to the proposal, but they still want assurances that whoever they nominate can beat Donald Trump next November. And as views from her home state show, Medicare for All offers reason for caution on that front. 

Steve Koczela and Rich Parr are the president and research director of the MassINC Polling Group. The polling group is a for-profit subsidiary of MassINC, the publisher of CommonWealth.