He returned on Saturday under slightly different circumstances. President Donald Trump is finishing his sixth month in office and Senate Republicans are hammering away at an Obamacare overhaul that could cause more than 20 million people to lose insurance over the next 10 years. The campaign continues, but this time around it turns on health care -- beating back the Senate GOP bill while building up support for the single-payer plan Sanders will likely introduce in August.
Making the first of two scheduled summer visits here, the state that will play host to the first-in-the-nation caucuses of a still far-off presidential campaign season, Sanders kept up his broadsides against the Republican health care overhaul, calling it the most "anti-working class legislation in the history of the country." He named and tried to shame both of his Senate colleagues from Iowa, pleading with the Republicans repeatedly to reject the bill.
"I say to Sen. Grassley and Sen. Ernst, please, please take a hard look at what this disastrous legislation will do to the people of Iowa and the people of America," the Vermont senator said. "I beg of them: please vote 'no' on this legislation."
Had he arrived on the scene in Des Moines an hour or so earlier, Sanders might have been able to deliver the message personally to White House counselor Kellyanne Conway, who by some cosmic coincidence happened to be in town -- just an escalator ride away -- in the same building, speaking at the Family Leadership Summit, a gathering hosted by conservative evangelical activist Bob Vander Plaats.
Or perhaps Sanders will have the chance in a few years. His appearance, downstairs, at this annual convention sponsored by the progressive Citizens for Community Improvement, has juiced up speculation over his 2020 plans. Typically loathe to discuss the prospect, he did allow in an interview with liberal radio host Mark Thompson this week that he was "not taking (the possibility of a run) off the table, I just have not made any decisions."
If Sanders does take a second shot, he would join the contest as an early favorite, a popular national figure equipped with the infrastructure he lacked in 2015 and 2016, both organizationally and in the form of elected officials eager to make a show of their common cause.
Cathy Glasson, a nurse and union leader, was among the Sanders-loyal candidates making the rounds at the downtown Iowa Events Center. She is one of a hearty field of Democrats vying for the party's gubernatorial nomination in 2018, a race made suddenly more appealing with the departure of Republican Gov. Terry Branstad, who left office to become the Trump administration's ambassador to China.
"We want to change the dynamic in 2018," Glasson said, arguing that victory for Iowa progressives -- like her --- in the midterm season could "set the frame for presidential candidates when they start coming through. It's the very start of something fantastic that can happen right here in our own state to drive a national agenda as well."
But organizers here are almost reflexively averse to overindulgence in presidential chatter. It's not a parry. Republicans' inability to move on policy in Washington, while their GOP colleagues in state houses build heavy majorities and rack up legislative wins, hasn't gone unnoticed. Nor has the utility -- as evidenced in the fight to turn back Trump policy -- of controlling high-profile statewide offices.
"It's extremely premature for anybody to talk about 2020, because we need to take things back in 2018," Robert Becker, who ran Sanders operation in Iowa last year, said as attendees filled workshops on Medicare-for-all and climate action. "It's not a campaign that ended, it's beginning and evolving. The energy is up and down (the ballot)."
As has become commonplace, especially as Capitol Hill holds Obamacare in the balance, Sanders' one-two on health care -- a defense of the Affordable Care Act, for which he has traveled the country rallying support, then a push to "Medicare for all," the single-payer system that is growing in popularity on the left -- drew roaring ovations in Des Moines.
"What's important about 'Medicare for all' specifically is that he's saying you can beat something with nothing," said Michael Lighty, the public policy director for National Nurses United. "And the ACA simply isn't popular enough to take a purely defensive stand and expect victory."
No matter how the Senate vote breaks down, Sanders will be taking his proposal public in the coming weeks. While the bill is politically unfeasible in the current Congress, the plan among supporters is to brand the policy as a Democratic Party staple. For activists with their sights set high, simply making the pitch represents a chance to keep close with the grassroots.
"He is going to areas where the Democrats have done badly since 2010," Lighty said, rattling off the states and regions -- western Pennsylvania, Ohio, West Virginia, Kentucky -- Sanders has visited over the last month. "So this is not just about health care."