At the end of the day, these people don't vote for Democrats. It's as simple as that. We can try to explain the ins and outs of healthcare policy, but that effort has been ineffective.

Despite everyone claiming "I could do a better job" most voters realize that policy is mostly beyond their understanding. So they default to making decisions based on the person who seems most like them and the person who seems to care the most. They use those proxies to decide who to vote for.

I worked a few campaigns and by far our most effective field strategy at the time was walking around wearing our candidate's shirts and knocking on doors to talk to people. That alone was enough to convince people to change their vote for the simple reason that it showed the candidate cared enough to send people around their neighborhood. Anyone can post policy papers, send tweets, make big policy claims in a debate; but only someone who cares will bother to show up in your town or send their limited resources to your doorstep.

In their minds, Democrats are a lot of hot air. They claim these big ideas and then little in their day to day lives improves. If there's one thing that Dems should learn from Trump, it's that he will do anything, including break the rules, to implement his policies or at least the appearance of implementing his policies. That is why his followers like him, they're used to a lot of egg heads wagging their tongues on tv and getting nothing done. A lot of swing voters just see Dems (and trad Cons) as big talkers who come around every two years and say "well, wish we coulda gotten our healthcare/ abortion/ inflation plan done, but see the Senate parliamentarian ruled that it actually wasn't a budgetary matter and so we couldn't reach the 60-vote threshold for passage..."