Conor Lamb decisively won the health care vote in the Pennsylvania special election • VOX
 Jeff Swensen/Getty Images

Jeff Swensen/Getty Images

Health care was a top issue for 52 percent of voters, and they broke hard toward the Democrat.

By Dylan Scott

Conor Lamb beat Rick Saccone in a stunning upset in the Pennsylvania 18th congressional district’s special election on Tuesday night — and, in an equally striking result, health care beat tax cuts.

This race was decided by less than 1,000 votes, so any number of issues could have been decisive. But health care can make a compelling case that it put Lamb over the top.

Public Policy Polling, the left-leaning outfit, released an exit poll on Wednesday morning from the Pennsylvania race. This is what they found:

  • Health care was a top issue for 52 percent of voters: 15 percent said it was the most important issue for them and another 37 percent said that it was very important.
  • The health care voters broke hard toward Lamb: 64 percent of those who said it was their No. 1 issue backed the Democrat, and 62 percent of the people who said it was very important supported him.
  • Obamacare broke even in a district that Donald Trump won by 20 percentage points in 2016: 44 percent of voters supported the law, and 42 percent opposed it.
  • Meanwhile, 52 percent of PA-18 voters said they opposed the Republican plans to repeal the health care law, and only 39 percent approved.

Lamb sounded like a moderate Democrat on health care — he ran ads promising to protect Medicare and health care coverage generally. He said on his website:

The Affordable Care Act has flaws, but it has provided affordable coverage to more than a million Pennsylvanians who were previously uninsured.

Our representatives in Congress should be working together to build on that progress, fix what isn’t working, and make the law better. Instead, Republicans in Congress spent the past year trying to take health insurance away from people with no plan to replace it. Now, costs are likely to go up for many of us, especially those with preexisting conditions. That is unacceptable, and it’s a failure of leadership.

Republican leaders have not even allowed a vote on a bipartisan, common-sense effort to strengthen the ACA and stabilize the markets.

In my conversations over the last few months, Democratic operatives have made it clear they think health care can be a winner for them. Preexisting conditions, in particular, have proven to be a potent message, as well as the mainstays like Medicare. You can also bet that they will make a lot of hay out of any premium spikes we see in the fall, given that experts placed the blame squarely on Trump for the bulk of last year’s increases.

If PA-18 was a test run, it seems like a Democratic message of “Republicans tried to take away your health care, hiked your premiums, and endangered protections for preexisting conditions” can work even in a solid-red district.

The GOP’s counterpunch was supposed to be their tax bill, the signature achievement of the 115th Congress. A month ago, as my colleague Tara Golshan documented, two-thirds of the pro-Saccone TV ads were touting the tax plan.

But they didn’t break through, and Lamb continued to climb in the polls. Saccone was leading by 12 points back in early January; by the beginning of March, Lamb was pulling into the lead.

The tax bill is getting more popular, according to the polling. But it’s still roughly a wash with the public, and it doesn’t appear to have the same power to get people to the voting booth that health care does. It’s not at all clear that Republicans have an alternative plan.

The last-ditch pro-Saccone ads shifted the terrain to immigration, but that doesn’t seem to have worked (and let’s remember the Virginia governor’s race, where the Republican candidate went all-in on a Trump-style attack over immigration and lost in a historic landslide).

We’re still a long way from Election Day, of course. But the policy debate, non-Trump division, is shaping up to be health care versus tax cuts. Right now, you’d rather be running on the former.

Mahender Nathan