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The most important issue in an election is sometimes, but seldom, the factor that actually determines the outcome of the election. That's what we saw happen in Virginia this week. Health was the top issue in the Virginia race, according to exit polls, but it was only one of many factors that drove the election.

The bottom line: The election may have been more of a referendum on President Trump than health care — but the results in Virginia and in the Maine referendum on Medicaid expansion will still have a practical impact on what happens next, including the appetite for Affordable Care Act repeal and for cutting Medicaid to pay for tax cuts.

Expand chart
Data: Fox News voter analysis, Nov. 7; Chart: Axios Visuals

The details: Voters in Virginia named health care as far and away their top issue in the election in the network exit poll. It's not surprising that the issue was at the top of their minds; they have been hearing all about the ACA in the news for months and about Medicaid expansion in their state.

Yes, but: Notably, the exit poll did not include the economy on the list of issues voters could choose. Fox News did ask about the economy and, as the chart shows, it and health were statistically tied in their poll.

Between the lines: When voters rank health care as a top issue in an election, it does not necessarily mean health care drove their vote. Voters' views of the candidates themselves are generally a bigger factor. The candidates were also proxies for voters' feelings about President Trump, and many more voters in Virginia said they were voting to express opposition to Trump than their support for him (34% vs. 17%).

Most voters who chose health care as their top issue in Virginia voted for Northam, possibly signaling that Democrats may be able to campaign on health care and the ACA in upcoming elections.

What to watch: The Maine vote on Medicaid expansion was a different story. Maine voters cast their ballots on a specific referendum to expand the Medicaid program, and it won resoundingly. The result speaks to a lesson learned in the repeal and replace debate: Medicaid and Medicaid expansion are far more popular than Republicans seem to think they are, largely because Medicaid now covers 74 million Americans and matters to a broad cross section of the American people.

The impact: The immediate political implication is that it will be much tougher to cut Medicaid to help pay for tax cuts. Another lesson is that expanding Medicaid could be a winner in other states, especially with the federal government picking up 90 percent of the costs and the Trump administration ready to let red states put a conservative stamp on their programs. Medicaid is not Social Security or Medicare yet, but politically it is a lot closer than Republicans may realize.

A lot can and probably will happen between now and 2018. But for now, the prominence of health care in the Virginia election could throw a scare into moderate Republicans about continuing to pursue ACA repeal. And the Maine referendum on Medicaid expansion could make them more cautious about cutting Medicaid.

Go deeper

Updated 4 mins ago - Politics & Policy

Omicron dashboard

Illustration: Aïda Amer/Axios

  1. Health: Omicron fuels the case for COVID boosters — Omicron variant lifts Moderna's stock price — CDC strengthens COVID booster recommendation.
  2. Politics: Biden says fight against Omicron won't include "shutdowns or lockdowns."
  3. States: Federal court blocks Biden's vaccine mandate for health workers in 10 states — NYC urges masks indoors "at all times" regardless of vaccination status — New York declares state of emergency amid concerns over Omicron.
  4. World: Omicron adds urgency to vaccinating worldWHO warns against travel bans on southern African countries — First North American Omicron cases identified in Canada.
  5. Variant tracker: Where different strains are spreading.
Kendall Baker, author of Sports
Updated 13 mins ago - Sports

College football gone mad

Former Notre Dame coach Brian Kelly walks in front of his players. Photo: David Madison/Getty Images

In the span of two days, the head coaches of two of the biggest college football programs in America have jumped ship, wooed by even greater challenges — and the almighty dollar.

Driving the news: Lincoln Riley is ditching Oklahoma for USC in a deal reportedly worth $110 million. LSU poached Brian Kelly from Notre Dame with a reported 10-year, $100 million contract.

Media startups anxiously await BuzzFeed’s stock market debut

Illustration: Sarah Grillo/Axios

Digital media companies considering going public are watching BuzzFeed's expected stock market debut next week to see how investors will respond.

Why it matters: A slowdown in SPACs (special purpose acquisition companies) earlier this year pushed some digital media companies that were considering going public via SPAC IPOs away from the idea, such as Vice.

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