(CNBC) — Health care was the top issue for Americans voting in Tuesday’s midterm elections — for an understandable reason. Spending on medical care has skyrocketed in the past 20 years, hitting record levels in 2018 and weighing on both workers and employers.

More U.S. voters cited it as their top concern on the ballot, ahead of the economy or any other issue, for the first time in at least a decade, according to exit polls by NBC News.

Forty-one percent of those polled cited health care as their top issue, followed by immigration, at 23 percent. Roughly 70 percent of all voters, Democrat and Republican, said the U.S. health-care system needs “major changes,” while only 4 percent said it needed no changes at all.

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