HILLSBORO, Texas — Rep. Beto O'Rourke is taking a page from the Ted Cruz campaign playbook — he’s running for the Senate on health care.

Six years ago, Cruz won a tough Republican primary fight and coasted to a November victory by vilifying Obamacare, relentlessly vowing to repeal the federal health law if he were elected.


Now O'Rourke (D-Texas) is hoping for just the opposite effect — that fears over losing health care will bring voters out in large numbers in the state with the highest uninsured rate in the country. It’s an uphill path — no Democrat has won a Senate seat from Texas in three decades.

Asked at a recent town hall what would energize Texans who don't normally vote, O'Rourke had a simple answer: health care.

“The overriding concern throughout Texas, big cities and small towns alike, Republicans and Democrats, is our ability to be well enough to do the things we’re intended to do in our lives,” he said.

Yet while the health care message may resonate with Democrats nationally, polls in Texas tell a different story. Health care may not be enough to tip the balance in favor of Democrats in this deeply conservative state.

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Only 7 percent of registered voters polled in June — and 11 percent of Democrats — listed health care as the top issue facing Texas, behind immigration, border security and political corruption, and tied with education, according to the Texas Politics Project of the University of Texas.

“The people who are having the roughest time with the health care system are non-voters,” said Jim Henson, director of the Texas project. “I don’t think [health care] would be salient in a way that would lead people to reconsider a vote for a Republican.”

A recent Kaiser Family Foundation/Episcopal Health Foundation survey, for example, found that nearly 70 percent of Hispanics in Texas had trouble affording health care, but the Texas Politics Project found that only 4 percent of Hispanics ranked it as the most important issue facing the state.

Still, the campaign has seen massive fundraising hauls. O’Rourke raised $10.4 million in the second quarter of the year — more than double what Cruz brought in. With four months until Election Day, O’Rourke has a campaign war chest of $14 million, compared with $10 million for Cruz, and he says that most of the money comes from small donors within the state.

And both Cruz and O’Rourke have been emphasizing the importance of the Senate seat in shaping the national health care debate — and the differences between the two candidates couldn’t be more stark.

The odds are against O’Rourke. But the crowds love him. Will any of that matter in November?

At a town hall last Friday morning in Hillsboro, just north of Waco, a standing-room crowd of a couple hundred people, most there to hear O'Rourke, packed into folding chairs and leaned against the blue walls of a county courthouse in historic downtown.

While O’Rourke no longer uses phrases like “single-payer” or “Medicare for all,” the crowd cheered when he talked about the need for “universal, guaranteed, high-quality health care for all.”

And unlike Democrats running in other red states who hope to capitalize on the popular parts of Obamacare that kept Congress from repealing the law last year, O’Rourke isn’t shy about saying it doesn’t go far enough in providing universal coverage.

“We all get that what we have now might have been better than what preceded it," he said, citing Obamacare's protections for people with pre-existing conditions and the option for children to stay on a parent’s insurance until age 26. "But it is insufficient as premiums continue to go through the roof."

The message resonated among those who attended the gathering.

“I believe in single payer,” said Sue Talent, a retired state employee, who came with her husband, David, a former heavy equipment mechanic. Both said that health care was the biggest issue facing state residents, although they have coverage through Veterans Affairs and the state.

Will Lowrance, who was mayor of Hillsboro from 2000 to 2006, said he hadn’t seen so many people in the town show up for a Democratic candidate in 25 years.

“Usually 30 people would be good,” Lowrance, a registered Republican who normally votes Democratic, said at the coffee shop next door, which was playing Christmas music in July. “I’m encouraged by the turnout.”

Despite the wild enthusiasm of O’Rourke supporters, however, he remains a long shot in most recent polls. And moving to the left on health care seems unlikely to help him garner enough new Democratic votes come November.

“O’Rourke is going to try to use health care to his advantage,” Republican strategist Matt Mackowiak said. “I don’t know how effective that is going to be — Texas is more conservative than the rest of the country."

The reality is that the Talents and Lowrances are outliers in this community. Cruz, who had entered his 2012 primary race as a distinct underdog, won the Senate that November with 73 percent of Hill County's vote. President Donald Trump carried the county in 2016 with 77 percent of the vote. And seven times as many Republican as Democratic county residents cast their votes in the primary this past March.

There was a statewide Democratic surge compared with four years ago — more than a million Democrats voted in the gubernatorial primary this time, nearly double the number that cast ballots in 2014. But the total Republican primary election turnout was bigger — over 1.5 million Republicans turned out to vote in March, a slight uptick from 2014.

And the enthusiastic support that O'Rourke's focus on health care has brought may pose a particular danger to the numbers: It has heightened the sense of urgency for Republicans.

Shortly after O’Rourke wrapped up his town hall in Hillsboro, Cruz held a campaign gathering at Shrimp Boat Manny's in Livingston, a couple of hundred miles southeast.

“It was chock-a-block full,” said owner Manny Rachal, who said that he had trouble finding space to park all the cars.

While the national Republican Party has largely moved on from Obamacare (for now), Cruz — who thrust himself onto the national stage by forcing a government shutdown over the health law in 2013 — is still citing repeal as one of four priorities for Republicans. He’s been touting his party's success in zeroing out the individual mandate penalty for not having health coverage.

Rachal agreed, calling Obamacare a “bad deal.” On Medicare himself, he’s skeptical of government efforts to expand coverage because of costs passed on to taxpayers.

“We’re in Texas,” said Rachal, who supported Trump over Cruz in the 2016 presidential primary. “We’re not in Vermont."