Health care mostly has ranked low on voters’ list of concerns in 2016 — but that could change as people get hit with high, often double-digit premium increases under Obamacare just as they prepare to cast their ballots.

The Department of Health and Human Services announced last week that premiums for the second-cheapest “silver” plan on the health care exchange will rise next year by an average of 25 percent for 27-year-olds. The hikes will be substantially higher in some key swing states. In Arizona, the rates will more than double. In North Carolina, the figure is 40 percent. In Iowa, it is 25 percent.

“What is more targeted than a letter from the government to the head of a household telling him that his second-biggest expense is going up by 50 percent?”

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Polling suggests that the contest between Republican Donald Trump and Democrat Hillary Clinton is close to a dead heat in all three states. In Pennsylvania, where Clinton has a 5-point lead according to a CNN/ORC poll released Wednesday, the average increase will be 53 percent — one of the steepest increases in the country.

“The timing of this for Obamacare is terrible because it’s right near the election,” said Josh Blackman, a Houston School of Law professor who has studied the Affordable Care Act extensively. “People are logging on to the health care website now.”

Trump and running mate Indiana Gov. Mike Pence both gave speeches on the issue Tuesday in Pennsylvania, and the GOP nominee has vowed throughout the campaign to repeal the president’s landmark law. For most of the earlier stages of the contest, though, it was not a front-burner issue. A Kaiser Family Foundation poll last week found that just 5 percent of of Republican voters — and 9 percent of Democrats and 6 percent of independents — rated health care as their most important issue.

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Blackman, author of “Unraveled: Obamacare, Religious Liberty, and Executive Power,” said the unusual nature of the candidates and the campaigns pushed the health law to the side.

“Without the craziness going on, Obamacare would be the biggest issue,” he said.

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[lz_table title=”Obamacare in the Swing States” source=”Department of Health and Human Services”]Premium Changes in Key 2016 States*
|State,2017 Premium,Change
North Carolina,$446,40%
*Average for 27-year-old on second-cheapest “silver” plan

Jason Pye, a spokesman for the conservative group FreedomWorks, said the rate hikes could tip the outcome in closely contested states like North Carolina and Arizona. But he added that the impact of the looming increases, which voters are just finding out about, is blunted by the fact that so many ballots already have been cast in early voting.

Pye said Republicans should have done a better job keeping up the pressure before the rate hikes became official.

“People should have really been hammering this home for months,” he said. “Unfortunately, they haven’t — or maybe not as much as they should have.”

But Matt Schlapp, chairman of the American Conservative Union, said the notices people are receiving in the mail are more powerful than all of the “micro-targeting” that Democrats famously employed in President Obama’s presidential campaigns to tailor specific messages to individual voters.

“What is more targeted than a letter from the government to the head of a household telling him that his second-biggest expense is going up by 50 percent?” he said. “It just blows by all the other communications they’re getting.”

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The Affordable Care Act never has been broadly popular. A Gallup poll in August indicated that 51 percent disapproved of the law, up from 49 percent in a survey earlier this year. Approval dropped from 47 percent to 44 percent. Asked if they expected the law to make their family’s health situation better in the future, just 24 percent said “yes,” while 36 percent said it would make their situation worse. By an 11-point margin, respondents also were more likely to say the law already had hurt their family.

Polls have consistently shown a sharp partisan divide, with most Democrats sticking by the law. But Schlapp said a big premium increase “changes the calculus, for sure.”

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Grace-Marie Turner, president of the Galen Institute, said the fact that Trump hit the issue this week shows that internal polling indicates it is gaining traction. She said many people will experience increases well above that 25 percent. She said businesses, too, are dealing with massive increases.

Turner, whose organization favors market-based health reforms, also rejected the argument that most people are shielded from the impact of the rate hikes because they receive taxpayer subsidies. Although proponents of the law claim 85 percent of the customers on the health care exchanges get subsidies, she noted that millions of Americans who do not qualify for assistance buy plans on the individual market.

Their premiums will rise along with the subsidized customers, Turner said.

“That’s 10 million people hit with the full impact of the increases in Obamacare,” she said. “Talk about a pocketbook issue. This hits people directly, and it’s coming one week before the election.”