Robby Mook, the manager for Hillary Clinton’s presidential campaign, urged staff to attack National Nurses United (NNU) as “fringe” and suggested they were “not a ‘real’ union,” according to emails published by WikiLeaks.

NNU gave Bernie Sanders one of his biggest union endorsements. The nurses union also invested a lot of time and resources into get out the vote efforts and hosted a major People’s Summit in June that brought all the forces, which were supportive of the Sanders campaign, together in Chicago to explore how to carry on a people’s agenda after the election.

RoseAnn DeMoro, executive director of NNU, responded, “The Clinton team’s attack on nurses as ‘fringe’ and not a ‘real union’ is deplorable, but hardly a shock. It’s a window in how they seek to vilify any critics, as evidenced in other emails showing Clinton’s mocking disdain for environmental activists.”

DeMoro continued, “Apparently, a ‘real union’ is only one that falls lock step within the Democratic Party establishment and ‘fringe’ when it fails to embrace partnerships with Wall Street and other corporate interests.”

“Sadly, it’s also a preview of what we can expect in the next four years and a reminder that—from day one of the Clinton administration—NNU and our allies will need to make our voices loudly heard to advocate for social, economic, and political justice for patients and all people.”

On August 9, 2015, the labor outreach director, Nikki Budzinski, indicated NNU would endorse Sanders. It was the first national labor endorsement the campaign failed to win.

Mook replied, “On the nurses—can we be ready [with] background for the press team on how fringe they are? Also have they praised HRC before?”

“I would be wary of trying to attack them as fringe,” Budzinski advised. However, she said the press would “love this story” and “finding a creative way to shake it I think is worth the effort.”

Mook agreed and added, “I’m just worried less experienced reporters won’t understand that they’re not a ‘real’ union.”

NNU is, in fact, a “real” union. It is an AFL-CIO member union. It is also the largest union of registered nurses in the United States.

In July 2015, Mook favored lobbying NNU leadership to prevent them from endorsing Bernie. That pressure clearly failed.

The campaign pit the nurses of the American Federation of Teachers (AFT) against the nurses of NNU, trotting them out to deaden the impact of NNU’s support for Sanders. Campaign chairman John Podesta even seemed to welcome AFT president Randi Weingarten’s pledge to “go after NNU and there [sic] high and mighty sanctimonious conduct.”

Individuals connected to the campaign continued to keep track of NNU and their efforts to support Sanders. Tina Flournoy of AFT notified the campaign when NNU sent out a press release condemning the Democratic National Committee for its attempt to rig the primary process by denying Sanders access to a master list of voters.

Clinton campaign staff likely considered NNU “fringe” because the nurses union took a principled stand on the Affordable Care Act (ACA). They pushed for single-payer healthcare and still refuse to settle for anything less than Medicare for All.

At a Democratic Platform Committee meeting in June, DeMoro criticized the ACA, as well as the Clinton campaign’s proposals for incremental market-based reform that would barely address human needs.

Clinton and DNC appointees to the Platform Committee blocked the Democratic Party from including language that would have suggested the party supports expanding Medicare to cover all Americans.

“The Affordable Care Act, while an improvement, is not good enough. It is structurally deficient [and] leaves healthcare as a system based on profit and ability to pay rather than patient need,” NNU declared in a statement after the platform committee voted down the single-payer language.

It still means tens of millions of American have no “health coverage or ‘insurance’” because they cannot afford “high out of pocket costs.” Plus, the law has systemic problems which undermine quality of care, and it is easy for the health care industry to game the system, NNU added.

President Barack Obama’s administration confirmed premiums under the ACA will go up about 25 percent. Many Americans will only have one insurance provider to choose from when buying insurance through exchanges.

The spike further undermines the arguments of progressive establishment figures, who insist the ACA must be defended at all costs, including against calls to establish a universal health care system that would truly put people before profits.

Finally, some of the worst attacks from Democrats and the Obama administration came in 2009 and 2010 against groups and organizations, which did not immediately fall in line and support the ACA. They lashed out those committed to single-payer healthcare or a much weaker reform, the public option.

The conduct of the Clinton campaign suggests this type of disdain for principled challenges from progressives will continue under a Clinton administration, and in fact, a Clinton administration may be more crude and vicious in their efforts to stamp out dissent.