The coronavirus pandemic is a lingering reality that will play an outsize role in the 2022 midterm elections. But it is a different issue than it was in 2020, when Democratic presidential nominee Joe Biden could simply promise to do a better job than Donald Trump. In 2022, Democratic candidates have to not just be against the dishonest and dysfunctional responses of Republican ideologues to the pandemic. They have to be for an agenda that assures this country is prepared to respond to the ongoing threat posed by Covid-19 variants and the prospect of future pandemics that could be even more deadly.

To get the issue right, Democratic candidates must acknowledge the disproportionate impact of the Covid crisis on working class communities, especially communities of color, and the systemic inequities that have historically contributed to health disparities in the United States.

With that in mind, and with the midterm election season now ramping up, Democratic candidates and strategists would be wise to look at the approach adopted by a pair of Texans who are top contenders in the state’s primary election on March 1. While centrist Democrats claim that this is a time to pull back from progressive promises for sweeping health care reforms, congressional candidates Jessica Cisneros and Greg Casar beg to differ. They argue that the pandemic—which saw the state frequently experience the highest Covid death rate in the nation—has provided searing evidence of the need for a single-payer “Medicare For All” system.

“Health care is a human right and we must ensure every working family has access to the doctors and prescriptions they need to stay healthy—and there is no better solution than passing Medicare For All,” declares the campaign of Casar, who is running in an open-seat contest to represent the heavily-Democratic 35th congressional district, which stretches from East Austin to San Antonio.

As an activist member of the city council since 2014, Casar has earned national headlines as an advocate for worker rights, immigrant rights, and reproductive rights. Before the 2020 presidential primary in Texas, it was Casar who introduced Vermont Senator Bernie Sanders to a huge crowd in Austin. When the pandemic hit, Casar threw himself into the grassroots work of expanding access to health care in Austin, assuring that nurses and other essential workers were protected, and getting Covid testing and vaccine sites opened up in the neighborhoods that were hardest hit by the pandemic, primarily low-income communities and communities of color. He got high marks for his efforts, but the candidate recognized, “We need federal action to ensure our working families, schools, and communities can protect themselves and their loved ones from COVID-19.” And from all the other physical, emotional, and economic challenges that arise when health care is not readily available.

A veteran organizer, Casar is well aware that, even if Congress remains under Democratic control, and especially if Republicans take charge of the House, the fight for “Medicare for All” will be a difficult one. During the course of the primary campaign, Republicans and more centrist Democrats have criticized him for being too ambitious with his agenda. But Casar says he is excited to join Representative Alexandria Ocasio-Cortez, the New York Democrat who campaigned for him last weekend in downtown Austin, to “shake the halls of Congress” on the issue.

“Folks have asked: How do you feel about being in the progressive minority in Congress? I believe that is the wrong question for us to ask,” said Casar as a rally launching his campaign. “The right question for us to ask is: If the overwhelming majority of Americans believe we should have Medicare for All instead of Go-Fund-Me’s for life-saving medication—if that’s what the overwhelming majority of people think—then who really is in the minority?”

South of the district where Cesar is making his primary bid, immigration and human rights attorney Jessica Cisneros is mounting a high-stakes Democratic primary challenge to Representative Henry Cuellar, one of the most conservative members of the House Democratic Caucus. She has made advocacy for Medicare For All one of her top issues in a race against an incumbent she came within four points of beating in 2020.

“Congressman Cuellar voted to weaken the Affordable Care Act, reducing the number of workers eligible for coverage and making long-term and comprehensive care more expensive,” recalled Cisneros. “In Congress, I will fight to ensure that health care is a right, not a privilege. That’s why I support single-payer, Medicare For All which would insure every American with comprehensive health care—eliminating premiums and deductibles and expanding coverage to include dental, hearing, vision, and mental health, while lowering overall costs to families, small businesses, and government.”

Cisneros, who is also backed by Ocasio-Cortez, as well as Sanders and Sen. Elizabeth Warren (D-Mass.), addresses health care issues in practical terms as she runs in the heavily-Hispanic 28th district, which hugs the border between the United States and Mexico and was hit hard by the pandemic. “No family should have to go into Mexico to receive safe and affordable medical treatment, and no one should die from not being able to afford care,” said the challenger. “Before the COVID-19 pandemic, 24 percent of us in TX-28 didn’t have health insurance, leaving our community particularly vulnerable to the global public health crisis. The average family with health coverage is spending $12,000 out of pocket on health care premiums. This is unacceptable.”

Like Casar, Cisneros also highlights the need to guarantee access to comprehensive family planning resources and contraception—in stark contrast to the incumbent, who opposed efforts by congressional Democrats to challenge restrictions on abortion rights in Texas. “People on the border shouldn’t be forced to go into Mexico to receive health care services like mammograms and Pap smears,” she said. “I firmly believe in every person’s right to choose and make decisions about their own lives and their own bodies, not our government—or men like Henry Cuellar.”

If Jessica Cisneros and Greg Casar win their primaries on Tuesday, the signal from Texas—a state where conservative Republican officials have in recent months used misinformation and fearmongering to attack everything from trans rights and abortion rights to mask requirements and vaccine mandates—will be a big one. It will signal that voters aren’t going to be distracted from the reality that the current health care system has not served them well.

“What we do here in South Texas to try to fundraise for medical expenses is sell plates of food by the side of the highway,” said Cisneros in a recent reflection on why she supports fundamental reform. “We know that this is a policy choice.”

And, as Casar said, “the big structural way of dealing with it is to pass a single-payer, Medicare for All system.”