Virginia Democrat Tom Perriello released a new campaign ad in his bid for governor where he blasts Republican attempts to overhaul the health care system while an ambulance is crushed in behind him, a possible early look at how the fierce policy battle will extend to airwaves across the country.

Perriello, who lost his 2010 Congressional re-election bid after voting for the Affordable Care Act, unveiled the spot a little more than an hour after the U.S. House voted Thursday to repeal and replace the law.

In the 32 second-ad filmed in one take, Perriello shouts over the din as a scrapyard car crusher flattens an ambulance.

“Republican leaders are trying to do this to affordable health care,” a barely audible Perriello says, before vowing to protect Virginia’s access to health care.

The ambulance window bursts into shards of glass as Perriello says “together we can stop Donald Trump.”

(No functioning ambulances were harmed in filming; a campaign spokesman says it was an out-of-service older model with no engine. The crusher was also far louder than the campaign expected.)

Perriello’s campaign has yet to determine the extent of the ad buy and where it will air, leaving it unclear whether the unusual commercial is designed to garner attention through paid advertising or free social media and news reports.

Perriello’s opponent in the June 13 primary, Lt. Gov. Ralph Northam, has also defended the Affordable Care Act on the campaign trail, and blasted the pending Republican replacement bill as “spineless, unprincipled cruelty” in statements on Thursday. Northam, a pediatric neurologist, features his medical background in his first commercials.

“As a doctor, Ralph Northam has been fighting for a fairer healthcare system his entire career,” said David Turner, a Northam spokesman. “Virginians know he’s helped lead the fight to implement the Affordable Care Act in the commonwealth and expand Medicaid to 400,000 people. Republicans should be ashamed of the bill passed today, and Dr. Northam is going to call them out for their spineless.”

Jennifer Duffy, an analyst at the nonpartisan Cook Political Report, said she wouldn’t be surprised to see more ads like Perriello’s aired against vulnerable House Republicans and gubernatorial candidates, who would end up implementing provisions of the health care bill if it becomes law.

“This kind of ad rings bells for Democratic activists who are furious about this,” said Duffy.

Nathan Gonzales, editor and publisher of the nonpartisan Inside Elections, cautions that the original Affordable Care Act was fresh on the minds of voters in the 2010 election because it passed just seven months before. A new health care overhaul may not be as salient in the 2018 election cycle, he said.

Because Virginia is one of only two states electing governors this year, Perriello “is in a distinctly unique position to take advantage of this energy now when the issue could have a totally different feeling by the time we get to the mid-term,” said Gonzales.

The winner of the Democratic primary will face off against the Republican nominee in November. Three Republicans, former Republican National Committee chairman Ed Gillespie, Prince William County Board of Supervisors Chairman Corey Stewart and state Sen. Frank Wagner of Virginia Beach are in a three-way fight for the GOP nomination, also to be decided June 13.