Congressional candidate Dan McCready shakes a voter's hand last month. Photo: Tom Williams/CQ Roll Call

Today's special election in North Carolina for a House seat is ostensibly the first big test of 2020 — but its messaging is straight out of 2018.

Driving the news: Democrat Dan McCready has made health care — and drug prices, specifically — a centerpiece of his advertising and broader pitch to voters as he tries to turn a red district blue.

What we're seeing:

  • The McCready campaign has run two ads devoted to drug prices, both of which attack GOP candidate Dan Bishop for voting against a bill to let pharmacists tell patients about cheaper drugs.
  • House Democrats' campaign arm came in with two more ads on the same theme (including a somewhat bizarre ad casting Bishop as a superhero for pharma).
  • Even the Environmental Defense Fund — not usually the biggest player in health care fights — echoed the same attack in an anti-Bishop attack ad.

Thought bubble: This race is about a lot more than just health care. It's a redo from 2018; it's a district Trump won big; and Trump himself campaigned for Bishop last night.

  • But McCready's decision to focus so intensely on health care reinforces that Democrats still see this as their best line of attack in competitive races, and that the national debate over "Medicare for All" isn't scaring them away from more moderate messages on health care.

And if McCready wins, it'll be a sign that strategy does still seem to work, or at least to help.

Go deeper: Trump makes last-ditch North Carolina election push for GOP candidate

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