Here are five takeaways from the two special elections on Tuesday: The victory of Republican Karen Handel over Democrat Jon Ossoff in the sixth district of Georgia, and also, the much-less-heralded victory of Republican Ralph Norman in the fifth district of South Carolina.

First, all politics is local. The former incumbent in Georgia 6, Tom Price, now President Trump’s Health and Human Services Secretary, had an invincibly safe seat for more than a decade; he was re-elected in 2016 with 62 percent of the vote. And yet at the same time, Donald Trump won the suburban Atlanta district with just 48 percent last year, edging out Hillary by a single point.

In fact, Georgia 6 is changing: Although it is routinely described as “ruby red,” it is not. Like many affluent suburban districts nationwide, the white-collar folks there don’t see themselves as Trump Nation. Moreover, the sixth is increasingly diverse, in part because affluence attracts an ever-growing population of service- and domestic workers, most of whom are non-white and all of whom are non-affluent. And so Price’s ability to win the district easily was a tribute to Price himself, and to the power of incumbency.

By contrast, Handel, Price’s replacement, has had a middling track record in electoral politics. Having won, and lost, in local government, she was elected to be Georgia’s secretary of state in 2006, and then, four years later, she lost the GOP gubernatorial primary. So while Handel obviously has her strengths, she was no vote-monster; her ultimate showing on Tuesday lagged nearly ten points behind Price’s benchmark.

Similarly, in South Carolina 5, Mick Mulvaney, now Trump’s Director of the Office of Management and Budget, had won huge in that district—by 21 points last year. By contrast, this year, Norman, running against a self-funding Wall Streeter, Archie Parnell, won by a mere four points.

Of course, in both cases, a win is a win. And so Handel and Norman should be proud of their victories, even as should now be look to secure their districts.

Second, all politics is local—except when it’s national. Early on, Ossoff caught the anti-Trump wave among #Resistance-minded Democrats; his campaign boasted the Bernie Sanders-ish tagline, “Make Trump Furious.” Even though he was only 30 years old and had never run for office before, he united his increasingly left-leaning party; it’s been a long time since Peach State Democrats even thought about nominating a good ol’ boy. In the April 18 first-round balloting, Ossoff’s new-style campaign raised an remarkable amount of cash, more than $8 million, powering him to garner 48 percent of the vote and thus the Democratic nomination.

Since then, Ossoff raised many millions more. Interestingly, 95 percent of his haul has come from outside of Georgia; as a matter of fact, he raised more money from the San Francisco Bay Area than from home. And ultimately, the perception that Ossoff was likely to vote more like a Californian than a Georgian probably crippled the young man’s candidacy.

For her part, Handel had barely any money at all as of April, and yet when she secured the Republican nomination, the money came pouring in. Although her candidacy was never the same sort of crusade as Ossoff’s, Republicans backed her big-time, because they could see that a defeat in Georgia would be costly to their legislative momentum in 2017, as well as to their hopes for holding the House in 2018.

So, greatly aided by an all-out effort from House Speaker Paul Ryan and his GOP colleagues in Congress, Handel’s campaign ultimately commanded more resources than her Democratic foe. What Handel lacked in emotional enthusiasm, she more than counterbalanced with the national Republican Party’s financial and technical competence.

Third, special elections tend to go against the party in the White House, so any Republican today faces a stiff wind. And why is that? Why vote against the President? The answer is not unique to Trump or even to Republicans—it applies to presidents of both parties. And the logic behind this historical verity can be stated simply: Once their candidate has taken the White House, supporters of the “in” party tend to grow complacent. After all, their guy won.

Meanwhile, supporters of the “out” party tend to be grow more upset, if not downright angry. It’s human nature; people who have lost are more motivated to lash out than people who have won. We can add that this energization of the “outs” is particularly noticeable in low-turnout special elections, when usually only the hard core voters. So that’s why specials often lead to upsets that confound the normal partisan order.

The results of this “anti-in” special-election syndrome were seen spectacularly early on in the Obama administration. After Democratic Senator Edward Kennedy died in late 2009, the people of Massachusetts went to the polls to replace him. As usual, the “outs” were more riled up, and thus it was the anti-Obama voters who thronged to the polls to support Republican Scott Brown. So even though Obama had won the state by 25 points in 2008—and Kennedy had won by 39 points when he ran for the last time in 2006—Brown won a comfortable five-point victory in that special election. (We can add that Brown was himself defeated by Democrat Elizabeth Warren by a wide margin in 2012, thus underscoring the fluky nature of special elections.)

So now we can fast-forward to 2017, when the old outs are in and the old ins are out. This dynamic made for a lot of Republican nail-biting in this year’s special elections.

In the April 11 contest in Kansas to replace Mike Pompeo, now the Trump administration’s CIA Director, the GOP candidate, Mike Estes, won by seven points. That’s not a bad margin, and yet it is noteworthy that just last November, Pompeo had won the same district by 22 points. And in Montana, Republican Greg Gianforte won the May 25 special election by six points, whereas his predecessor, Ryan Zinke, now the Interior Secretary, had won by 16 points. And so now with the latest results from Georgia and South Carolina, we can see: In the four contests, the average fall-off in GOP victory margins was 13 points. So it’s a good thing that the GOP had plenty of “cushion” in those races!

Once again, Republicans should be happy that their candidates prevailed in all of these contests, but the trend-lines have been clear: Republican turnout has been down, and Democratic turnout has been up.

We can further observe that this tendency toward “out” mobilization extends beyond special elections to the Congressional midterm elections. A look back at electoral history tells us that these contests are often tough for the “in” party. In fact, in the last century, the “ins” have lost ground in 22 of the last 25 midterms.

Fourth, President Trump is a nationally polarizing figure, but he’s not the only one. Right now, that polarization is not helping Republican candidates. According to the RealClearPolitics presidential approval polling average, Trump’s approval rating hovers around 40 percent, while his disapproval rating is around 54 percent. In other words, he suffers from a 14-point popularity deficit.

When a president’s ratings are under water like that, it’s harder for the party’s down-ballot candidates to get the political oxygen they need. Yet at the same, candidates for the opposing party have a ready-made campaign theme: They can urge voters to “send a message” to the unpopular White House incumbent. A headline in Tuesday’s Washington Post tells that tale: “In Georgia House election, a referendum on the president.”

Of course, polarization can cut both ways—it can cut against the Democrats, too. And that’s what happened on Tuesday: The Republicans wrapped House Minority Leader Nancy Pelosi around the necks of both Ossoff and Parnell. Hence the apt headline in Politico on Tuesday morning: “Handel vs. Ossoff is Trump vs. Pelosi in the end.” And since Pelosi’s upside-down favorable/unfavorable ratio makes Trump’s look good, the gain was to Handel.

So we can see: In a slugging match of polarizations, anti-Trump vs. anti-Pelosi, the Republicans had the stronger hand.

Fifth, there’s the policy elephant in the room: healthcare. That is, if we were to go looking for a single issue that has done the most to pull down Trump’s popularity, it’s probably healthcare, specifically, the issue of repealing-and-replacing Obamacare.

To be sure, in 2016, Trump campaigned, vaguely, in opposition to Obamacare, and yet at the same time, he carved out a profile of himself as a different kind of Republican, one free of the usual GOP budget-minded orthodoxy. As he said repeatedly during the campaign, he was not interested in cutting Medicare or Medicaid. Indeed, Trump actually had a long record, reaching back decades, of supporting comprehensive health insurance—even Canada-style “single payer” insurance.

Thus we can see that on health issues as well as other issues, Candidate Trump positioned himself as a right-leaning centrist, in the tradition of, say, Dwight Eisenhower. So it’s not then surprising that Trump won the electoral votes of states, including Pennsylvania and Wisconsin, that Ike had carried, long ago, but had since been voting mostly Democratic.

Yet now, President Trump seems to have become a more orthodox conservative; he hasn’t touched Medicare, but he has sought reductions in Medicaid, which is increasingly a lifeline for the working lower-middle class, as well as the non-working poor. This change in Trump’s policy profile is obviously pleasing to some, although, as the polls suggest, it’s displeasing to more.

So now we come to the hottest-button healthcare issue, Obamacare. It’s worth noting that support for Obamacare has actually been rising in the last six months. Interestingly, that legislation, formally known as the Affordable Care Act, had been more unpopular than popular since the summer of 2009, when the Tea Party got going—and yet now the law is enjoying a comeback.

Why this comeback? Perhaps because for the first time, it seemed possible that the law could be repealed, and the public doesn’t want that. Or perhaps it’s because Trump disapprovers flatly and completely despise anything Trump supports, and so, in this instance, Obamacare is the beneficiary.

So it’s through this snowy environment that the Republican repeal-vehicle, the American Health Care Act (AHCA), has had to sled. And as we know, it’s been rough sledding indeed. (This author has argued, repeatedly, that Republicans would have been better off focusing on some other issue early on, such as tax reform, infrastructure, or even, as a paradigm-shift in healthcare, a crash program for medical cures.) So as Republicans look ahead, they might be thinking with even greater urgency about agenda items that offer the middle class the prospect of fatter paychecks and better jobs.

In the meantime, AHCA is finding itself deep in the drifts. A compilation of recent polls by FiveThirtyEight.com found that the bill is down in the polls by more than 20 points. And a June 12 poll in The Atlanta Journal-Constitution poll showed that just 25 percent of Americans supported the bill, while 62 percent opposed it.

Indeed, even Trump, while supporting the bill overall, has indicated that he wants to see Congress make some modifications; he has called AHCA, as passed by the House on May 4, “mean.” Indeed, just on Tuesday, White House Press Secretary Sean Spicer, eyeing the Senate’s work on the same legislation, said that the President “clearly wants a bill that has heart in it.”

Still, given the salience of the healthcare issue—Gallup finds it tied for second place on the list of Americans’ concerns—and the unpopularity of AHCA, it’s hard to see how the woes of the national GOP on healthcare weren’t a burden on Handel’s campaign. Of course, she won, and yet now she, and all GOP incumbents, will have to think about how to proceed, as the Senate seems destined to vote on its version of the AHCA. Obviously Republicans have come too far on healthcare to turn back now, and yet they would do well to carefully consider the fine points of whatever it is that they are seeking to enact into law.

One astute observer who thinks that Republicans need a course-correction is former House speaker Newt Gingrich. He knows suburban Atlanta well; he first won the area for the GOP way back in 1978, bringing an end to more than a century of Democratic dominion.

Yet on Monday, Gingrich published an opinion piece headlined, “GOP, slow down on killing Obamacare.”

In that article, Gingrich cited the shifting tide on the healthcare issue, and so he urged a careful, not hasty, legislative strategy: “This measured, slower approach to repealing and replacing Obamacare may not have been the ideal scenario Republicans imagined in their high spirits after winning the election in November. But given current circumstances, it is the responsible choice of a governing party dedicated to solving problems in the most practical way.”

That’s good advice. Because while the Republicans made it through this thicket of special elections unscathed, there are more thorns in their path: The 2017 elections in New Jersey and Virginia are just around the corner. And after them, the 2018 midterms.