LAS VEGAS — Senator Bernie Sanders is a longtime supporter of “Medicare for all.” “I wrote the damn bill,” he said on a debate stage last summer, and his support for universal health care has helped propel him to the front of the 2020 Democratic field.
But in Nevada, where the race heads next, his signature policy is a liability with the largest labor union in the state. And the union has enthusiastic allies in Mr. Sanders’s opponents.
On Friday morning, moments after Senator Amy Klobuchar finished a tour of the health care facility run by the culinary workers’ union, she began to lace into Mr. Sanders and his focus on the proposal, which would effectively eliminate union members’ current health care system.
It is unwise and unrealistic, she argued, to eliminate the private health insurance that millions of Americans now use — or to think such a measure could pass.
“Since we’re in Vegas I’d say if your number is not on the wheel, maybe you don’t want to bet on that number,” Ms. Klobuchar said.
A night earlier, former Mayor Pete Buttigieg of South Bend, Ind., raised the issue at a forum for Latino voters. “Who are we to tell them that they have to give up those plans?” Mr. Buttigieg said of the culinary workers’ health care coverage.
Then there’s Tom Steyer, the billionaire self-funder, who is competing aggressively in Nevada and has started airing a commercial that says “unions don’t like” Mr. Sanders’s plan and includes a vow to protect “union negotiated plans.”
The flurry of attacks against Mr. Sanders in Nevada illustrates his growing strength — and the urgency his Democratic rivals feel about the need to stop him from winning the most votes in a third consecutive contest next Saturday. If no Democrat slows Mr. Sanders in the caucuses here, he will gather what may be unstoppable momentum heading into next month’s Super Tuesday states.
But the offensive against the Vermont senator also highlighted some of his most glaring vulnerabilities: The culinary union, which represents many of the workers in Las Vegas’s casinos, is opposed to his single-payer plan. And after its leaders stated that opposition, they were met with the sort of scathing and personal invective that critics of Mr. Sanders often receive.
Culinary Workers Local 226, which is 60,000 members strong and over half Latino, is perhaps the most powerful force in Democratic politics in this state. And there is no benefit its members cherish more than the health care coverage they’ve won in their contract negotiations.
“For their membership, that is the key issue, that is the 800-pound gorilla,” said Richard Bryan, a Nevada Democrat who served as governor and senator.
Mr. Sanders argues that Medicare for all is the only way to guarantee universal coverage, lower costs and bring the nation in line with other industrialized nations, making it both more competitive and just. In Nevada, as he has around the country, he is pitching it as a core part of his agenda for the working class.
Supporters of Medicare for all argue that everyone should be entitled to the same kind of care for which union members negotiate. At a town hall event with culinary union members late last year, Mr. Sanders said that they could expect more money in their paychecks if they did not bargain with employers over health care.
But leaders of the culinary union say his plan would hurt members and their families. After years of organizing, difficult negotiations and multiple strikes, the union won a generous private health insurance plan that leaders are loath to give up. They are wary of the idea that Medicare for all, should it ever pass, would be better than the private plan they have now.
Their unease is shared by other unions, but it’s particularly important because of the culinary union’s clout in Nevada, this pivotal moment in the primary calendar and because it complicates Mr. Sanders’s overarching message — that he’s running on an agenda that’s best for workers.
Suzanne Poquiz, 61, a resident of Las Vegas who was visiting the union health care clinic Friday morning, said she was still undecided but knew she would not vote for Mr. Sanders because of his stance on health care.
“That’s the most important issue to me, being able to come here and get what I need,” Ms. Poquiz said.
What could prove just as problematic to Mr. Sanders, though, is not his split with the culinary union over policy — but over how his supporters handled the dispute.
The fight began last week after the union began distributing fliers to members, comparing the candidates’ stances on policy.
“End Culinary Healthcare,” reads the first bullet point beside Mr. Sanders’s name on a flyer.
It was an unwelcome criticism, made worse by the reaction among some of Mr. Sanders’s supporters. Geoconda Argüello-Kline, the union’s secretary-treasurer, said she received hundreds of emails, phone calls and texts calling her names and threatening her. Her home address was posted online, she said, and her adult children were worried about her safety.
“I believe in the democratic process, and to have this happen is very scary,” Ms. Argüello-Kline said. “After many years as an activist, after many strikes, I have never felt that way in my life. And we are not telling people how to vote — they can make their own decision.”
The vile language prompted Mr. Sanders to issue a statement, in which he said “harassment of all forms is unacceptable to me” and urged “supporters of all campaigns not to engage in bullying or ugly personal attacks.”
But his general reference to “all campaigns” only further angered some of the union leaders, who, like many of the rank-and-file members, are women of color. Ms. Argüello-Kline said that she wished Mr. Sanders would have spoken out sooner to help quell the threats.
“He understands the world we live in, where there can be a shooting anytime at a church or a school or a casino — that’s the environment we’re in,” she said.
A top aide to Mr. Sanders, Ari Rabin-Havt, declined to discuss how the culinary union’s opposition may affect the campaign in the state, saying only that the senator has ”the utmost respect for them.”
By Saturday, though, former Vice President Joseph R. Biden Jr. was seizing on the matter on NBC’s “Meet the Press,” condemning “vicious, malicious, misogynistic” statements by Sanders supporters even as the senator’s aides pointed to his comment that “anybody making personal attacks against anybody else in my name is not part of our movement.”
The response in Nevada to Mr. Sanders’s stance on Medicare for all also shows a split among two of his bases — union members and young Latinos. Several other local hospitality unions have endorsed Mr. Sanders, and young Latinos often cite his health care plan as a key reason for their support.
Even among culinary union members, there is a strain of quiet support for Mr. Sanders. In interviews with several union members over the weekend, several said they were backing Mr. Sanders regardless of what the union’s leadership said. Some said they felt stuck in their jobs because leaving would mean losing coverage, and they wanted family members to have access to care as well. “I think his medical plan is really good, I think it is good for everybody,” said Laura Alvarez, 44, a housekeeper at the Aria who voted in the early caucus at the union’s hall Saturday. “We deserve to have a good medical plan. If it’s going to be for everyone, I think that would be the best thing we could have.”
Even as the culinary union’s leaders criticize Mr. Sanders, their decision to not offer an endorsement of any leading alternative may have only helped him — a fact that has irked some of Mr. Biden’s leading Nevada supporters.
If no single rival to Mr. Sanders emerges in the days before the caucuses, Nevadans could render the same muddled or narrow verdict as their predecessors in Iowa and New Hampshire, a result that would benefit Mr. Sanders.
And veterans of Nevada politics say that’s looking even more likely in part because of the presence of a candidate who has spent more than $10 million in television advertising here but was less of a factor in the first two states: Mr. Steyer.
“For a lot of people, that’s all they’ve seen is Steyer, Steyer, Steyer,” said Megan Jones, a Democratic strategist in the state, who said her father had received about “16 pieces of Steyer mail.”
Ms. Jones said that Mr. Sanders’s dedicated supporters, Mr. Steyer’s spending, the residual organizational strength of Mr. Biden and Senator Elizabeth Warren and the new attention Ms. Klobuchar and Mr. Buttigieg were enjoying were likely to lead to another split decision.
“I don’t see a scenario in which anybody gets more than 30 percent,” she said.
A poll taken last week and published Friday by The Las Vegas Review-Journal captured the fractured nature of the field: Mr. Sanders leads the field, but all six of the top candidates were in double digits.
One big open question among many in Nevada is turnout. With the culinary union not backing a specific candidate, it is unclear whether its operation will encourage members to show up to the caucuses in droves.
D. Taylor, the president of Unite Here, the national union that Culinary is affiliated with, said that despite the direct involvement of the union in Nevada, many labor leaders throughout the country wanted to stay out of the primary and instead focus on defeating President Trump in the fall.
“It doesn’t take a rocket scientist to say it looks like there’s a split between the progressive and moderate wing of the party,” he said. “I don’t know that there’s a whole lot of benefit for us to get into that.”