This story tells one that I’m hearing over and over.  The state concerns are the national concerns.  From the Wall Street Journal:

That’s the warning from the unlikely quarter of Tuesday’s special state senate election in Kentucky that became a referendum on the Democratic agenda in Washington, especially health care. Voters in the 14th District elected Republican Jimmy Higdon over Democrat Jodie Haydon by 12 points. That’s significant in a district that leans Democratic by more than 2 to 1, and where Democrats and their allies spent more than $1 million, perhaps twice what the GOP did.

While the Democrat campaigned on local issues and jobs, Mr. Higdon focused relentlessly on the national controversy surrounding health care. In direct mail, TV and radio ads, the Republican stuck to variations on the theme that it was time to “end Nancy Pelosi’s one-party rule” and that “if [Kentucky's capital] Frankfort becomes like Washington, Kentucky health care will be placed at risk.” Given the vast new Medicaid burdens that will be put on states, he is exactly right, and voters took the point.