There has been some discussion about whether the election on November 6 was actually a “blue wave,” but when one party takes 33 seats away from the other party in the House of Representatives—which was the total at printing deadline—that’s a wave.

One lawmaker caught up in that wave was Republican Congressman John Faso. During the campaign, he tried to convince voters that he would not try to end protections for people with pre-existing conditions. But, after voting to do just that, and after twice voting to advance legislation that would have ended the Affordable Care Act—and kicked 23 million Americans off their health insurance plans—many people in his district did not believe him.

Democratic Congressman-elect Antonio Delagado put the issue of healthcare front and center in his campaign, as did many other candidates across the country. That is what helped to trigger the wave. The wave is not as big as the one Republicans and the Tea Party sparked in 2010, when the Republicans turned over 63 seats in the House, but that’s at least partly because Republicans were in charge of a majority of state houses following the 2010 census, and were able to gerrymander districts, making it tough for Democrats to mount effective challenges in many districts.

The two waves were both tangled up with healthcare. In 2010, Tea Party candidates were livid that President Barack Obama and the Democrats had passed the Affordable Care Act and created a national program to help more people have access to health insurance. In 2018, Democratic voters were just as livid that President Donald Trump and Republican lawmakers including John Faso wanted to take that program away.

Faso had a tin ear on the issue of healthcare for his entire term. He repeatedly attacked Gov. Andrew Cuomo over the cost of the state’s Medicaid program, which is paid for in part by counties.

In July 2017, in an ongoing battle with the governor, Faso released a statement that said in part, “Over 30% of New Yorkers are on Medicaid, and our state’s Medicaid program costs over $60 billion each year—that’s more than Texas and Florida combined.”

It’s true that the state’s Medicaid program is expensive, but it pays for benefits that many people use and believe in. Medicaid pays for a program that is credited with getting pre-natal care to every pregnant woman in the region. Through Planned Parenthood, Medicaid pays for delivering birth control, pregnancy tests and screenings for thousands of women in the region.

Across the country, Medicaid pays for nearly half of all births in the United States. When Faso was constantly attacking Medicaid, he was directly attacking a program that many young mothers had counted on to ensure the health of their babies.

Faso also faced the accusation that he cared more about his wealthy donors than he did about his constituents. Billionaires Robert Singer and Richard Mercer plowed a million dollars into Faso’s 2016 campaign to help him win the seat. Once elected, Faso pretty much refused to hold open, town-hall style meetings with constituents, and would later hold meetings with constituents with the provision that questions be provided in advance.

Faso called town hall meetings unproductive, and his attitude sparked the formation of many groups in the New York 19th Congressional District with the main goal of opposing Faso, including “We Are One–Sullivan.”

Delgado took full advantage of the lack of a solid connection between Faso and most of the people who live in the district. He held town hall meetings in all 11 counties that make up the district.

One of Delgado’s main talking points was that the federal government has been captured by the wealthy and powerful, who run it for their own benefit at the expense of the rest of us. His website says, “A small minority of the super-rich and powerful have sought to control our elections using dark money, massive redistricting efforts, and campaigns to repress voter rights. Simultaneously, our President has expressed his contempt for the Constitution both by questioning the role of the Judicial Branch and by lining his pockets with payments from foreign powers in violation of the Emoluments Clause. I believe that we need to immediately fight to preserve the integrity of our democracy, by pushing for reform to address Citizens United, gerrymandering, and the restriction of voters’ rights.”

In a campaign with blatantly racist overtones, Faso tried to paint Delgado as a “big city rapper,” who didn’t fit in with the values of the upstate communities in the 11 counties in the district. Many analysts labeled ads attacking Delgado as racist, especially those targeting his time as a rap artist. Faso did not try very hard to distance himself from the ads.

In the end, the number of voters who went to the polls was 27% higher than in the midterm in 2014. Most of the counties in the district, including Sullivan, voted for Faso by small margins, but Delgado took Ulster with nearly 16,000 more votes than Faso received, and that was enough to turn the district blue.