It’s getting ugly in the Keystone State — even though it’s not getting competitive. Democrats in Pennsylvania have latched onto health care as a motivating issue for its base to get to the polls, and have had a lot of success in leveraging it to big leads up and down the ballot. Politico calls it “a blue comeback,” and it’s amplifying the effect that a new congressional map has had on Democratic fortunes in a state Donald Trump narrowly won:

Pennsylvania was the linchpin of Donald Trump’s 2016 victory, but it could be ground zero of Democrats’ 2018 comeback. Not only are the incumbent Democratic senator and governor prohibitive favorites to win reelection, but Democrats could also pick up as many as a half-dozen congressional seats — roughly a quarter of the seats the party needs nationwide to win back the House.

Fewer than two years after Trump became the first Republican presidential candidate to carry Pennsylvania since 1988, a new POLITICO/AARP poll shows both Sen. Bob Casey and Gov. Tom Wolf with double-digit leads over their GOP challengers. And Democrats have a slight edge on the generic congressional ballot — which, combined with a new, court-imposed congressional-district map unwinding GOP gerrymandering, portends major gains in next month‘s elections.

The top issue for voters in Pennsylvania is health care: Nearly 3 in 4, 74 percent, say it’s “very important” to their vote in November, out-rating the economy and jobs (72 percent), Social Security (67 percent) and national security and terrorism (65 percent). For voters 50 and older, Social Security (81 percent) only slightly outpaces health care (79 percent).

The Politico/AARP poll isn’t an outlier, either. The RCP average for the Senate race puts Casey up 16 points over Republican challenger Lou Barletta, who hasn’t yet hit 40% in any poll this cycle. The only caveat to this might be whether a Kavanaugh effect might develop in Pennsylvania; the most recent poll prior to Politico/AARP took place in mid-September. However, Casey wasn’t on the Senate Judiciary Committee and didn’t go out of his way to raise his profile in that fight, perhaps (wisely) concluding that his big lead gave him a splendid opportunity to shut up.

Unfortunately for Casey, he didn’t take another good opportunity to shut up. In a new ad, Casey accused Barletta of wanting to deny health care to twin children who have been diagnosed with cancer. Barletta angrily reminded Casey that he told the senator in confidence about his own grandchild’s struggle with cancer — and Barletta’s demanding that Casey withdraw the ad:

Republican Lou Barletta has charged Democratic incumbent U.S. Sen. Bob Casey of “[releasing] an insensitive and personal attack ad,” against his family, where Casey accuses the Hazleton congressman of “wanting to rip away health insurance from twin children with cancer.” …

“This is everything that is wrong with politics,” Barletta said. “I personally told told Senator Casey about the miracle birth of my twin grandchildren and the fact that at 18-months-old, one is currently being treated for cancer.”

“For Senator Casey to use twins with cancer in an attack ad and say that I would deny my grandson health care is disgraceful. This is the lowest thing I’ve ever seen. Senator Casey should take down this disgraceful ad,” Barletta concluded.

Rick Santorum, whom Casey beat to win the seat, called the ad “despicable”:

Politics being what it is, I doubt that either side will back down. PennLive’s John L. Micek notes that Casey has been telling this story for years as part of his defense of ObamaCare, along with a few other anecdotes from Pennsylvanians. If so, though, the late entry of this particular story seems a little odd. Given Barletta’s personal situation, it smacks of a deliberate political strategy of painting Barletta as a bad grandfather.

Pennsylvania politics being what they are, though, it also seems unlikely to change the direction of the race. Even Donald Trump seemed to sense it last week:

Midway through another raucous arena rally last week, President Trump offered a revealing aside about Rep. Lou Barletta, the Republican he recruited to jump into Pennsylvania’s Senate race.

“I got him into this,” Trump said, musing about what he called “the only bad thing” about Barletta’s candidacy before thousands of supporters resplendent in red ball caps. “For the rest of his life, he could have been a congressman.”

Given what’s happened to the congressional map in Pennsylvania, redrawn by court edict, that’s questionable too. With all that in mind, the classy move would be to withdraw the ad and still win by double digits. Unfortunately, class is in short supply in politics these days, and not just in Pennsylvania.