Democrats largely protested a GOP effort to put senators on the record on a plan providing universal health care, but a handful running for re-election in Republican-leaning states decided to reject the single-payer system.

Sen. Steve Daines, R-Mont, introduced an amendment Wednesday night to amend the House-passed health care legislation currently on the floor and replace it with a Democratic bill giving every American health care through Medicare. Daines does not support the Medicare-for-All bill, but he argued that the American people should know Democrats’ position on the issue. Democrats cried foul, saying that Republicans were playing politics.

For Senate Democrats, a vote against the bill would risk angering the progressive Democratic base, with more liberal groups rallying around the single-payer option. But a vote for the bill could spark criticism from the moderate wing that is wary of a government-run health care system.

Asked if the Thursday vote put Democrats up for re-election in the 2018 midterms in the difficult position of taking a stance on a contentious intra-party issue, Democratic Senatorial Campaign Committee Chairman Chris Van Hollen didn’t respond directly.

“I think every member will vote based on what they think is best for their state,” the Maryland Democrat said.

‘Present’

And a handful of Senate Democrats in some of the most competitive re-election decided supporting the bill was not good policy — or politics. 

Forty three of the 48 Democrats voted “present” on the amendment. But four Senate Democrats and one Independent who caucuses with them all voted “no.” All of them are up for re-election in 2018, and the four Democrats are running in states that President Donald Trump won in November.

“We need realistic solutions to help fix our health care system and I’ll keep trying to work across the aisle to do just that,” Sen. Heidi Heitkamp, D-N.D., said in a statement explaining her “no” vote. “The decision was made in 2010 to go with a market-based system — the question is how we improve the system we have.”

Sen. Angus King, I-Maine, also voted against the bill. That doesn’t necessarily express his final opinion on the subject, he said.

“But the bill had way too many complications” King said. “I didn’t think it was a good bill, so I voted no.”

Trump won one of Maine’s four electoral votes last November. Inside Elections with Nathan L. Gonzales rates King’s re-election race as a Solidly Democratic.

Three of the Senate Democrats in tossup races — Heitkamp, Joe Donnelly of Indiana and Joe Manchin III of West Virginia — also voted “no.” Sen. John Tester of Montana also rejected the amendment. His re-election race is rated Tilt Democrat.

Political trick? 

Those who voted “present” sided with Sen. Bernie Sanders, I-Vt., who supports single-payer but called the GOP amendment a “political trick” on the Senate floor. Sanders decided Wednesday night, in consultation with Senate Minority Leader Charles E. Schumer, that he would not be voting in favor of the amendment. And they encouraged fellow Democrats to do the same. 

One Democrat in a tossup race voted “present” even though she opposes a single-payer system.

“I am not for single-payer — said it a million times,” Sen. Claire McCaskill explained after the vote. “I’m for public option. I’m for buy-in on Medicare for 55-65. And … I don’t think anybody in Missouri is going to think I’m afraid of taking a tough vote. So I’m not worried about that.”

“But I am worried that they don’t realize what a sham this has become,” the Missouri Democrat added. “[Republicans] are now saying they will only pass a bill if they’re positive the House won’t pass it. This is like the twilight zone. I mean it’s crazy.”

McCaskill was referring to GOP leadership’s plan to pass a “skinny” repeal of provisions of the Affordable Care Act, so that the Senate could go to a conference with the House and negotiate a more comprehensive Obamacare repeal bill.

 The skinny repeal is still being drafted. Democrats accused Republicans of playing political games in the meantime. 

Sen. Christopher S. Murphy said he was not concerned that single-payer supporters would be angry that Democrats did not voice support for the legislation.

“People who are pushing single payer understand that this is a sham process,” the Connecticut Democrat said. “Once the dust settles on this repeal effort we’re going to have a really important conversation about what the future of U.S. health care is. But this is a total sham. We’re not going to let it dictate the terms of the debate on Medicare-for-All.”

Ken Zinn, political director for the National Nurses United, which supports the Medicare-for-All legislation, said he understood Democrats’ decision to vote present.

“As Sen. Sanders correctly pointed out on the Senate floor, this was a ploy by Sen. Daines,” Zinn said.

Zinn expected a renewed push for single-payer after the GOP health care votes this week, and expects Sanders to introduce his own Medicare-for-All legislation in the coming weeks.

Zinn said the union would be approaching the senators who voted against the amendment Thursday and urge them to support Sanders’ bill. He said those who do not support the proposal would “absolutely” face political blowback.

“The movement for single payer, Medicare-for-All, is growing by leaps and bounds across the country,” Zinn said. “Those who are not willing to go there are going to have to face the consequences when they face their constituents or their voters.”

Republicans were quick to criticize Senate Democrats for their votes on the bill, accusing them of ducking a policy the Democratic base supports. 

“Senate Democrats had the opportunity to put their money where their mouths are and vote for their own government-run health care plan, and they promptly went into hiding,” said National Republican Senatorial Committee spokeswoman Katie Martin.

Andy Van Wye contributed to this report. Correction:  A previous version of this story incorrectly stated Sen. Bill Nelson’s vote. The Florida Democrat voted “present.”