Montana’s wild election for an open US House seat is in the history books. And in the end, the result came in as predicted: a comfortable but not massive victory for Republican Greg Gianforte, even after his assault on a reporter on the eve of Thursday’s vote.

Now for the real test: the June runoff for an open House seat in suburban Atlanta. That’s the Democrats’ best shot at flipping a Republican-held seat in Congress before the November 2018 midterm elections. Polls show a tight race.

But even if the Democrats lose in Georgia too, the Republicans aren’t out of the woods.

“There’s no question that the House is in play” in the midterms, says GOP strategist Ford O’Connell. And if Democrats win control of the House, “the Trump experiment is essentially over.”

Several currents of voter thought are driving the narrative of what could prove to be a “wave election” next year, with lots of Republican-held seats in Congress going to Democrats. A top trend is concern about health care, as President Trump and and his GOP allies on Capitol Hill seek to repeal and replace the Affordable Care Act (ACA), aka Obamacare.

Another driving force is Mr. Trump himself, the most unpopular American president in modern history at this stage of his presidency, with job-approval ratings averaging just below 40 percent.

“Midterm elections are always a referendum on the president,” says former Rep. Tom Davis (R) of Virginia, who served as chairman of the House campaign committee. “The question is, do you put a check on the president or do you give him a blank check?”

Midterms are tough when the same party holds both the White House and the House of Representatives. In the last three midterms with those conditions – 1994, 2006, and 2010 – the majority party suffered an upheaval.

“The Democratic base is now very energized, and Republicans need to keep their base energized,” Mr. Davis says. “That means passing some of this stuff, passing tax reform. If they sit up there and do nothing for two years, their base becomes dispirited. But the Democrats don’t become any less intense.”

Midterm elections are all about who shows up, Davis notes, “and in my experience, it’s angry people who show up, and it’s usually the out party.”

Of course, there’s still 18 months to go. “For all the noise, Montana didn’t turn out very well for [the Democrats], even after our guy body-slams a reporter,” Davis says. “In fact, he did better on Election Day than he did with absentees.”

More than half of voters in the Montana special election voted early. But the race for the state’s at-large congressional seat, won by wealthy businessman Greg Gianforte by 6 percentage points, still holds plenty of clues for both parties as they look ahead to the Georgia runoff and the 2018 midterms.

The Obamacare-repeal backlash

Melia Fortunati, a 40-something soap maker in Missoula, Mont., points to her three-year-old daughter to explain why she voted for Democrat Rob Quist, a country-folk singer. Her daughter has a medical diagnosis that could hinder her ability to obtain health insurance in the future, if ACA protections for people with preexisting conditions are weakened or eliminated.

Sam Orr, a university student in Missoula, also cites a preexisting medical condition for his vote for Mr. Quist. “I was not with Gianforte and his support for getting [Republican-backed] health care passed,” Mr. Orr says.

The June 20 runoff for the open House seat in Georgia features a wholly different type of congressional district. While the Montana race covered the entire state, with lots of rural voters, the Georgia district held until recently by Health and Human Services Secretary Tom Price is suburban and has a higher percentage of college graduates. Trump barely won that congressional district, while he won Montana by more than 20 points.

In the Georgia race, “swing suburban women are saying they’ve had enough, because of the health-care issue,” says Celinda Lake, a Democratic pollster based in Washington.

But even if the Democratic candidate, Jon Ossoff, fails to win the Georgia race – leaving Democrats batting zero-for-three in special House races this year, after Montana and another special House election in Kansas – Ms. Lake is still energized for the midterms.

Path to potential upset in 2018

“We can retake the House without winning back any districts that are as Republican as these are,” says Lake, referring to the three House districts that have held special elections this year, including Georgia.

Democrats narrowed the gap among rural voters in Montana, Lake’s native state, as well as among suburban voters. Mr. Ossoff came close to winning a majority in the first round of voting in April, in a district that Secretary Price, a Republican, had won last November by 24 points.

Republicans running for election now “are in the worst of all positions,” Lake says. “They don’t have Trump’s appeal but they have all his problems.”

It’s also important to note that each race has its own circumstances, its own issues, and its own cast of characters. Montana’s profile as a rural state dotted with ranches and farms, and some of the nation’s most famous national parks, deeply affects voters’ perspective.

About an hour before the polls closed in Missoula, 30-something Greg Swanson cast his vote for Quist. A political independent and railroad worker, who voted twice for Barack Obama and most recently for Trump, Mr. Swanson says he considers every election separately and votes for who he thinks is the best candidate at the time.

“I like his Montana values,” says Swanson of Quist. “I think he’s here protecting Montana’s rights, outdoor spaces, and public lands.”

One aspect of Quist made him slightly uncomfortable – his stance on gun control. In January, the Democrat suggested a registry for automatic weapons. But Swanson says he still felt Quist was a better candidate than Mr. Gianforte on issues important to Montanans.

Conservative solidarity

In the main, Trump voters remain loyal to the president – and to the Republicans who back him. When Gianforte ran for governor of Montana last November, he distanced himself from Trump and lost. In the House race, he lashed himself to Trump and won.

Trump supporter Seth Tollefson says he’s glad Gianforte changed his stance on Trump. Mr. Tollefson, a business owner from Florence, Mont., says he voted for Gianforte regardless of the assault charges filed against him, after the incident Wednesday night with a reporter from The Guardian. Tollefson was also dismissive of concerns over the GOP’s attempts to repeal the ACA.

“I have health insurance so it’s not an issue that affects me,” Tollefson says.

An independent who voted for Gianforte, Austin Pugh, a semi-retired 50-something from Stevensville, Mont., says he used to vote Democratic but hasn’t in a long time. And he too appreciates Gianforte’s support for Trump.

“If they are allowed to do their job, they will make America great again,” Mr. Pugh says. “Gianforte will fall into line.”

Pugh was not bothered by Gianforte’s assault charges a day before the election, and says it seemed too convenient for the opposition that it happened then.

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“If Gianforte shoved someone, big deal,” Pugh says.

On election night, Gianforte apologized for his behavior toward reporter Ben Jacobs, but still faces legal action.