North Dakota Sen. Heidi Heitkamp Mary (Heidi) Kathryn HeitkampHarris faces pivotal moment with Supreme Court battle Centrists, progressives rally around Harris pick for VP 70 former senators propose bipartisan caucus for incumbents MORE (D) and Rep. Kevin Cramer Kevin John CramerNetflix distances from author's comments about Muslim Uyghurs but defends project Abortion stirs GOP tensions in Supreme Court fight Momentum growing among Republicans for Supreme Court vote before Election Day MORE (R) clashed over health care, tariffs and support for President Trump Donald John TrumpBiden says voters should choose who nominates Supreme Court justice Trump, Biden will not shake hands at first debate due to COVID-19 Pelosi: Trump Supreme Court pick 'threatens' Affordable Care Act MORE on Friday night in their final Senate debate.

Heitkamp and Cramer are battling in one of the most competitive races this cycle, with both parties hoping a win in the state could help deliver them the Senate majority.

Recent polls have shown the race trending away from Heitkamp, but the first-term Democratic incumbent hammered her GOP rival over ObamaCare on Friday as she defends her seat in a state President Trump won by 36 points in 2016.

Here are four takeaways from Friday night’s debate:

The gloves came off — eventually

The debate started on a more positive note, with both candidates calling for civility after a spate of pipe bombs were mailed to Democrats this week.

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And while the pair found common ground on issues like immigration and the Paris climate accord, the gloves came off when the topic shifted to health care.

Cramer and Heitkamp sparred for at least 10 minutes straight, uninterrupted by the moderators, with a series of zingers drawing audible reactions from the audience.

The candidates raised their voices in another heated segment on offering protections for people with pre-existing conditions and clashed in a fiery segment on tariffs.

And when discussing Social Security reforms, Cramer made an indirect reference to Heitkamp trailing in the polls.

“She’s in Hail Mary mode, I get it,” he said.

Other portions of the debate drew more light-hearted comments from the pair, including following a particularly long-winded exchange on health care.

"This is fun," Cramer said. "This is what they came here for."

"This is a real debate," Heitkamp agreed.

Health care brings sharpest clash

Health care continues to be the dominant issue in congressional campaigns this cycle. And like other competitive battleground races, pre-existing conditions became the biggest sticking point on Friday night.

Heitkamp continually railed against Cramer for his numerous votes to repeal ObamaCare while pointing to an anti-ObamaCare lawsuit from GOP-led states that threatens to unwind protections for those with pre-existing conditions.

“Let’s not fool ourselves: You voted five times to repeal ObamaCare, you’ve voted to eliminate that patient protection ... support of a lawsuit with the sole purpose of eliminating protections for pre-existing conditions,” she said. “I hear the double talk over there.”

“We can’t play politics with our health care,” she declared later.

Cramer responded that the plans he’s supported “without ambiguity” would protect coverage for individuals with pre-existing conditions and that states can provide that coverage.

He later referenced a family member who needs insulin, saying they have trouble affording it under the current system.

“If they can’t afford it today, they sure as hell can’t afford it tomorrow,” Heitkamp interjected.

Cramer countered that they could afford the medicine prior to the Affordable Care Act.

“That’s not affordable, that’s not access," he said. “That’s checking the box saying I have coverage I can’t afford to use.”

Cramer touts support for Trump

Cramer made it clear throughout the debate that he is an unequivocal ally of Trump's.

The GOP congressman touted the president's leadership when it came to Russia and his decision to impose steep tariffs on China.

Cramer explained that even when he and the president are at odds on policy, he largely backs the president's approach.

“I think the president might be acting prematurely, quite honestly,” he said when asked about Trump's decision to withdraw from the Intermediate-Range Nuclear Forces Treaty with Russia.

But he added later that “if he says he wants to do it this way, I’m going to support him.”

At one point, Cramer even apologized for breaking from the president when it came to whether to stay in the Paris climate agreement, something that drew audible reactions from both Heitkamp and audience members.

“This is where the president and I disagree — I’m so sorry, Mr. President,” Cramer said.

During another exchange over tariffs, Heitkamp sought to capitalize on Cramer’s ties to Trump.

“He’s all in on the president, and I’m all in on North Dakota,” she said.