Carolina hasn’t elected a Democrat to the US Senate in nearly 20 years, but former Governor Roy Cooper has built a double-digit lead over Republican Michael Whatley by relentlessly focusing on affordability and a blunt promise to “make stuff cost less.”At campaign stops, Cooper, 69, points to his six-year fight to expand Medicaid through a Republican-controlled legislature as evidence he can work across party lines, while attacking Trump-backed healthcare cuts that he says are hitting North Carolinians hard.

“People should not have to make a choice between going to a doctor and putting food on the table,” Cooper said at a September 26 rally in Raleigh, North Carolina. “This 'Big Beautiful Bill' that gave tax cuts to billionaires has now driven healthcare premiums up more than double for people.”The White House says the bill cuts taxes, protects Medicaid for eligible Americans and curbs fraud and abuse.

Cooper's message appears to be working: His lead stood at 14 points in an October SurveyUSA poll. The top super PAC for Senate Republicans has paused TV advertising in North Carolina less than three weeks before the election and begun shifting campaign dollars to defend seats in states that include Iowa and Kansas.

President Donald Trump will rally in the state on Tuesday for Whatley, a former Republican National Committee chair who has never held elected office.

The question for Democrats is whether Cooper's playbook can help them win Republican and independent voters elsewhere, or whether his success is unique to a popular former governor who has never lost an election in four decades of public service.

While some Democrats in heavily Democratic states have embraced Medicare for All, which would provide government-run health insurance for all Americans, Cooper has focused on expanding existing coverage and lowering costs. He points to his fight to expand Medicaid, the government health insurance program for low-income Americans, and campaigns on prescription drug and insurance costs.

“It’s like he’s our star athlete and no one’s paying any attention,” said Neera Tanden, president of the Center for American Progress, a Democratic-aligned think tank, and former White House adviser to President Joe Biden. “The strength of Roy Cooper’s campaign is that he’s able to attract Democrats and independents, but also even some Republicans because he’s focused on cost, but he also has a record.”Paul Shumaker, a longtime Republican strategist in North Carolina, attributes Cooper’s success to the fact he was already well-known and that Whatley failed to distinguish himself from Trump.

“Roy Cooper came to the US Senate race with a known brand that has been trusted by a majority of North Carolina voters election after election,” Shumaker said. “Republicans are suffering from a lack of trust on the economy right now and Whatley has failed to reestablish that trust.”Cooper declined an interview request for this story. The Whatley campaign did not respond to a request for comment. North Carolina’s electorate is unusually independent: 40% of registered voters are unaffiliated with either party, compared with 30% each for Republicans and Democrats. Republicans, however, have dominated the state legislature for more than a decade and redrawn districts to strengthen their grip.

Like other Republican candidates, Whatley must contend with Trump’s record-low approval rating, which now hovers at 32%, according to an October Reuters/Ipsos poll. That poll also showed registered voters preferring Democrats over Republicans nationally by 44% to 37%. Among independents, Democrats led 37% to 21%, with 28% of independent voters still undecided.

Republicans hold a 53-47 majority in the US Senate, where Democrats must net four seats in the November 3 midterm elections to control the chamber — an already difficult task that makes Cooper's North Carolina race especially important.

Cooper's signature bipartisan achievement did not come easily. It took him six years to persuade the Republican-controlled state legislature to pass an expansion of Medicaid under Obamacare in 2023, extending health insurance to more than 700,000 state residents, according to state health department data. After passage, he called it “an unnecessarily long and agonizing journey.”Whit Ayres, a Republican pollster, said several moderate Democratic governors in the South could replicate Cooper’s success, including Kentucky Governor Andy Beshear.

“The Roy Coopers of the world are not unique,” Ayres said. “The Republicans nominated someone who’s never been elected to any public office at any level anywhere running against a reasonably moderate, popular governor.”Many of the state’s Medicaid gains are likely to be undone by Trump’s “One Big Beautiful Bill,” a sweeping tax and budget bill the Republican-led Congress passed last year that cuts about $1 trillion from Medicaid, the largest cut in the program’s history, according to the nonpartisan Congressional Budget Office.

Cooper has used Trump’s signature domestic legislative achievement to paint the president and Republicans as depriving North Carolinians of healthcare in order to give billionaires more tax cuts.

He has also focused on congressional Republicans’ decision to curtail COVID-era Obamacare subsidies last year, causing healthcare premiums on the individual health insurance marketplace to spike and more than 200,000 state residents to drop their coverage, according to health policy research firm KFF.

“Roy Cooper has always polled over Republicans,” said Anderson Clayton, chair of the North Carolina Democratic Party. “This will be the average election for Roy Cooper.”