Angela Hart | (TNS) KFF Health News

BIRNAMWOOD, Wis. — The land of fried cheese curds and the Green Bay Packers is among a half-dozen battleground states that could determine the outcome of the expected November rematch between President Joe Biden and former President Donald Trump — a contest in which the cost and availability of health care are emerging as defining issues.

At church picnics and summertime polka festivals that draw voters of all political stripes, Wisconsinites said they’re struggling to pay for even the most basic health care, from common blood tests to insulin prescriptions. A proposal by Wisconsin’s Democratic governor to expand the state’s Medicaid program to thousands of low-income residents has become a partisan lightning rod in the affordability debate: Democrats want it; Republicans don’t.

In 2020, voters here gave Biden, a Democrat, a narrow win after favoring Trump, a Republican, in 2016. Recent polling indicates that the two rivals were neck and neck in this year’s race.

Many Wisconsin voters still can’t figure out whom to vote for — or whether to vote at all.

“I know he’s trying to improve health care and inflation, but I’m not happy with Biden,” said Bob Prelipp, 79, a Republican who lives in Birnamwood, a village of about 700 people in rural central Wisconsin. He reluctantly voted for Biden in 2020, after voting for Trump in 2016.

Prelipp was serving beer at the Birnamwood Polka Days festival on a muggy June day. Pro-Trump hats peppered the crowd, and against the backdrop of cheerful polka tunes, peppy dancing, and the sweet smell of freshly cut hay, candidates for local and state office mingled with voters.

This rural part of the state is ruby red. Trump flags fly over the landscape and businesses proudly display pro-Trump paraphernalia. Biden supporters are more visible and vocal in the Wisconsin population centers of Madison, the capital, and Milwaukee.

Biden “needs to get prices down. Everything is getting so unaffordable, even health care,” said Prelipp, a Vietnam War veteran who said his federal health care for veterans has improved markedly under Biden, including wait times for appointments. Yet he said he can’t stomach the idea of voting for him again, or for Trump, who has disparaged military veterans.

Prelipp said people are feeling nickel-and-dimed, not only at the grocery store and gas pump, but also at doctors’ offices and hospitals.

Greg Laabs, a musician in one of the polka bands at Birnamwood, displayed a pro-Trump sticker on his tuba. He said he likes his federal Medicare health coverage but worries that if Biden is reelected Democrats will provide publicly subsidized health care to immigrants lacking legal residency.

“There are thousands of people coming across the border,” said Laabs, 71. He noted that both Biden and Vice President Kamala Harris endorsed providing public health care to immigrants without legal residency as presidential candidates in 2019, a position that Harris’ home state of California has enthusiastically embraced. “We cannot support the whole world,” Laabs said.

The two main political parties will pick presidential nominees at their national conventions, and Biden and Trump are widely expected to be their choices. Republicans will gather in Milwaukee in July. Democrats will convene in Chicago in August.

Biden is trying to make health care a key issue ahead of the Nov. 5 election, arguing that he has slashed the cost of some prescription medications, lowered health insurance premiums, and helped get more Americans covered under the Affordable Care Act, also known as Obamacare. He has also been a strong supporter of reproductive rights and access to abortion, particularly since the U.S. Supreme Court struck down Roe v. Wade two years ago.

“The choice is clear: President Biden will protect our health care,” claims one of Biden’s campaign commercials.

Trump has said he wants to repeal Obamacare, despite multiple failed Republican attempts to do so over several years. “The cost of Obamacare is out of control,” Trump wrote last year. “I’m seriously looking at alternatives.”

Even Democrats who back Biden say the president must make it easier and cheaper to get medical care.

“I signed up for one of the Obamacare plans and got my cholesterol and blood sugar tested and it was like $500,” said Mary Vils, 63, a Democrat who lives in Portage County in central Wisconsin.

Beth Gehred, a Democrat who lives in Ashland County in northern Wisconsin, says rural communities need better access to health care, and she believes President Joe Biden is working on it. However, she says she is more worried about the state of democracy in the United States. “I know a lot of people on the fence right now between Trump and Biden,” she says. “People need to vote.” (Angela Hart/KFF Health News/TNS)

She strongly supports Biden but said people are feeling squeezed. “We’re fortunate because we had some savings, but that’s a lot of money out-of-pocket.”

Wisconsin Gov. Tony Evers, a Democrat, said he understands “the frustration that people have.”

Evers has repeatedly attempted to expand Medicaid to low-income adults who don’t have children, which all but 10 states have done since the enactment of Obamacare in 2010. The state’s Republican-controlled legislature has repeatedly blocked his efforts, yet Evers is trying again. Expanding Medicaid would provide coverage to nearly 90,000 low-income people, according to his administration.

Evers, who supports Biden, has argued that expanding Medicaid would bring in $2 billion in federal funding that would help reimburse hospitals and insurers for uncompensated care, and ultimately “make health care more affordable.”

Many states that have expanded Medicaid have realized savings in health care spending while providing coverage to more people, according to the Center on Budget and Policy Priorities, a think tank based in Washington, D.C.

“We have to get the Medicaid expansion money,” Evers told KFF Health News. “That would solve a lot of problems.”

Biden’s campaign is opening field offices in Wisconsin, and he and federal health care officials make frequent visits to the state. They’re touting Biden’s record of increasing subsidies for Obamacare insurance plans, and promising to expand access to care, especially in rural communities.

“Millions more people have coverage today,” said Neera Tanden, a domestic policy adviser to Biden, at a mid-June town hall event in Rothschild, Wisconsin, to announce $11 million in new federal funding to recruit and train health care workers.

She said the gains in Obamacare coverage have helped achieve “the lowest rate of uninsurance at any time in American history. That’s not an accident.”

Xavier Becerra, secretary of the U.S. Department of Health and Human Services, speaks in support of the Affordable Care Act, also known as Obamacare, alongside Neera Tanden, a domestic policy adviser to President Joe Biden, at a town hall event in Rothschild, Wisconsin, on June 13, 2024. (Angela Hart/KFF Health News/TNS)

But attendees at the town hall event told Tanden and the secretary of Health and Human Services, Xavier Becerra, that they have lost access to care as hospitals and rural health clinics have closed.

“We had a hospital that’s been serving our community for over 100 years close very suddenly,” said Michael Golat, an Altoona, Wisconsin, resident who described himself as an independent voter. “It’s really a crisis here.”

Becerra encouraged Wisconsin lawmakers to expand Medicaid. “Instantaneously, you would have hundreds of thousands of Americans in rural America, and including in rural Wisconsin, who now have access to care,” he said.

Cory Sillars, a Republican running for the Wisconsin State Assembly who campaigned at the Birnamwood polka festival, opposes Medicaid expansion and said the state should instead grant nurses the authority to practice medicine without doctor supervision, which he argued would help address gaps in rural care.

“If you’re always expanding government programs, you get people hooked on government and they don’t want to do it themselves. They expect it,” he said.

Sillars is running as a “pro-life” candidate with “traditional, Christian values,” an anti-abortion stance that some Democrats hope will backfire up and down the ballot.

Kristin Lyerly, an obstetrician-gynecologist and a Democrat, has made access to abortion and contraception central to her campaign to fill the congressional seat vacated by Mike Gallagher, a Republican who resigned in April.

Lyerly lives outside Green Bay but practices in Minnesota after facing threats and harassment, largely from conservative extremists, she said. She was a plaintiff in the state’s legal bid to block Republicans from halting access to abortions. Abortions still are not available everywhere in Wisconsin, she said.

“It is incumbent upon me as a physician and a woman to stand up and to use my voice,” Lyerly said. “This is an issue that people in this district might not be shouting about, but they’re having conversations about it, and they’re going to vote on it.”

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This article was produced by KFF Health News , which publishes California Healthline , an editorially independent service of the California Health Care Foundation .

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(KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs of KFF — the independent source for health policy research, polling and journalism.)

©2024 KFF Health News. Distributed by Tribune Content Agency, LLC.

Benjamin Oreskes | (TNS) Los Angeles Times

President Joe Biden’s widely panned debate performance Thursday night in Atlanta has many prominent Democrats asking a simple question:

What do we do now?

Swapping out Biden for someone else is likely not possible — unless he quits the race himself. He’s won the requisite number of delegates to capture the Democratic nomination, and Biden said Friday at a rally that he was in the race to win. So now strategists and donors are mulling how the 81-year-old can reset his campaign and take the fight to former President Donald Trump.

Some said the president needed to take a moment to survey the damage. Others said it was important that he increase his campaign travel schedule, do more media availabilities and emphasize how he’s always been an underdog. Some added that he needed to acknowledge his years and what Father Time has wrought rather than act as though age weren’t an issue.

Finally, there was broad agreement that Biden needs to home in on a message that contrasts his values and those of Trump, whom they describe as vain and vindictive.

“Bad debate nights happen,” former President Barack Obama wrote on X. “Trust me, I know. But this election is still a choice between someone who has fought for ordinary folks his entire life and someone who only cares about himself.”

Guests at the Old Town Pour House watch the debate between President Joe Biden and former President Donald Trump on Thursday, June 27, 2024, in Chicago. (Scott Olson/Getty Images/TNS)

Biden missed a chance to hit that note Thursday, several strategists said. They had wanted him to pick an issue such as reproductive rights or the economy, for example, and stay far more focused on how Americans would be worse off if Trump returned to the White House. They want him to do the same moving forward.

The president’s campaign “definitely needs more to offer clarity on the larger message they’re trying to convey with respect to Trump and how horrible he is,” Democratic strategist Bill Carrick said.

Rep. Ro Khanna, D-Calif., said Biden remained best positioned to lead the Democratic Party and that his past ability to overcome setbacks, tragedy and adversity offers a guide for how he should approach this moment.

Khanna, a frequent Biden surrogate on the campaign trail, suggested that the president stage a rally on the steps of the Philadelphia Museum of Art to evoke the image of Sylvester Stallone running up them in the iconic moment from the movie “Rocky.”

Biden has always styled himself as an underdog, and that shouldn’t change now, Khanna said. Thursday night’s debate was not Biden’s best showing, the congressman said, but doesn’t define him.

“Rocky wasn’t the most eloquent, but he was a fighter, and his eloquence was his character. I think that’s the line that we need to use: that Biden’s eloquence is his character,” Khanna told The Times.

“He needs to embrace the role of an underdog. He needs to embrace his role as having gotten knocked down in life and gotten back up,” Khanna said. “He’s not going to be a John F. Kennedy. He’s not going to be an Obama. He’s not going to be a Reagan. But he can be a Truman. He can be a Johnson. He can be a fighter.”

Being out among Americans right now is essential, Khanna added, suggesting that Biden barnstorm through the Midwest and meet with blue-collar workers and small-business owners.

Biden has done very few sit-down interviews or news conferences since taking office. He skipped the traditional Super Bowl halftime interview this year. In his first three years in office, Biden held 33 news conferences — half as many as Obama and fewer than Trump’s 52 over the same period, according to The American Presidency Project at UC Santa Barbara.

On Thursday night, the reviews of President Biden flowing in after the 90-minute were generally bad, with one accompanied by seven head-exploding emojis. Even allies have acknowledged he appeared off his A game.

It was “Bad night for Trump — but worse night for Biden,” Christine Pelosi, a Democratic National Committee delegate and daughter of former House Speaker Nancy Pelosi, said in a text message.

Biden “needs a course correct and a timely, long unscripted interview to show that this was a terrible debate — as Obama and Reagan both had with their first reelect debates — and not an ongoing condition,” she said.

One surprising element about Biden’s performance Thursday was how it differed from his energetic and forceful State of the Union Address in March. Biden was so strong that Trump and other Republicans suggested the president had been “jacked up” on drugs to perform so well.

But in the debate, Biden sounded hoarse and and at times struggled to complete sentences. Trump also spoke incoherently at times and, as fact-checkers pointed out, lied repeatedly. But Trump also spoke with more confidence, and the contrast in energy — Trump revved up, Biden halting — was startling to many viewers.

CNN announced that the debate averaged 51.3 million television viewers Thursday. The data do not include online viewing.

“I am very fond of ‘Joey Biden.’ But I believe he may well have done himself and those of us who understand what an effective president he has been existential damage,” said Joey Kaempfer, a real estate developer who has donated heavily to Democrats through the years. He has given close to $1 million to groups supporting Biden’s reelection and has dined with the president.

“We must be patient and see how the next week or two shakes out,” he said. “But yes, I am very concerned.”

President Joe Biden and first lady Jill Biden, with “Vote” printed on her dress, gesture to supporters during a campaign rally on Friday, June 28, 2024, in Raleigh, North Carolina. (Allison Joyce/Getty Images/TNS)

At a rally Friday in North Carolina, Biden appeared to heed some of this advice, particularly from those who said he needed to more fulsomely address the fact that he’d be the oldest president in history by the end of his second term. He delivered his points with more gusto and clarity than the night before and sounded more cogent.

Biden continued to attack the lies and lack of empathy Trump espoused at the debate — pointing to his comments on abortion, immigration and respecting democracy — and contrasting them with the accomplishments of his administration’s first term. He also addressed his age.

“I know I’m not a young man, to state the obvious,” Biden said Friday. “I don’t walk as easy as I used to. I don’t speak as smoothly. I don’t debate as well as I used to. But I know what I do know. I know how to tell the truth. I know right from wrong, and I know how to do this job.

“I know, like millions of Americans know,” he said, “when you get knocked down, you get back up.”

Biden at one point trumpeted his relationships with every world leader, “because I’ve been around, as you kind [of] have noticed,” which prompted laughs from the crowd. Exuding energy and not being defensive appeared to endear him to the supporters, and would it put him on a good path forward after the disastrous debate.

“Even with a great speech today — which I think is a good start — he needs many, many, of those, and he needs many many surrogates in the course of this,” former Republican strategist Matthew Dowd said on MSNBC.

There are 75 days until the next debate, he added, which means it will be a long time before many people tune into politics again. That’s a problem for Biden, Dowd said.

As if to address concerns about his stamina, Biden also attended two events Friday in New York City. The Associated Press reported that he joined Elton John in inaugurating a visitor center at the Stonewall National Monument, then attended a Pride Month fundraiser.

This was one of the earliest presidential debates in recent political history. Many analysts said it would focus voters’ attention on the race earlier and offer Biden a chance to shake up the trajectory.

Analysts had theorized that the Biden campaign also wanted an early debate because it would give him more time to repair any damage from a poor outing. That will now be put to the test.

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(L.A. Times staff writers Seema Mehta and Noah Bierman contributed to this report.)

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©2024 Los Angeles Times. Visit latimes.com. Distributed by Tribune Content Agency, LLC.

WASHINGTON — It’s hard to refer to someone as “Hitler” and end up in their good graces, let alone potentially become the person they choose to help lead the country.

But Ohio Sen. JD Vance’s shifting position on Donald Trump over the years from onetime critic of the former president to staunch ally is a metamorphosis shared by many of Trump’s potential running mates.

It’s not unheard of for a running mate to move beyond past disagreements with a presidential candidate.

Joe Biden had a notably barbed exchange with Kamala Harris in 2020 when both were seeking the Democratic nomination. Biden picked her to be his vice president anyway.

But the shift is more striking for Trump’s potential running mates, in some cases requiring them to abandon long-held policy positions and recant vehement criticism.

Here’s a look at some of those shifts:

JD Vance

In a 2016 interview with Charlie Rose while promoting his book “Hillbilly Elegy,” Vance called himself “a Never Trump guy” and said of the soon-to-be-president, “I never liked him.”

He told NPR that year, “I can’t stomach Trump.” He wrote an op-ed for The New York Times titled: “Mr. Trump Is Unfit For Our Nation’s Highest Office.”

Vance said he didn’t vote for Trump in 2016 and his former roommate shared images of a text message Vance sent him that year in which he called Trump “cynical” and said he could be “America’s Hitler.”

But by the time Vance launched his campaign for Senate in 2021, his views were closely aligned with Trump’s. He met with the former president and quickly won his endorsement, gaining a crucial boost in the Republican primary.

Vance has said he “was wrong” about Trump. In an interview this month on Fox News Channel, he was asked to explain his past criticism.

“I didn’t think he was going to be a good president,” Vance said. “He was a great president. And it’s one of the reasons why I’m working so hard to make sure he gets a second term.”

Marco Rubio

Some of the Florida senator’s harshest comments about Trump came as they sparred during the 2016 race. Trump started calling him “Little Marco” and mocking him. Rubio insulted Trump’s makeup and the size of his hands.

Rubio called also called Trump a “con artist,” and “the most vulgar person to ever aspire to the presidency.”

This year, when ABC News played back some of Rubio’s comments from 2016, he responded by saying, “It was a campaign.”

He made similar comments to CNN, saying “That is like asking a boxer why they punched somebody in the face in the third round. It’s because they were boxing.”

Their relationship improved dramatically while Trump was in the White House. And as Trump has campaigned for the presidency a third time, Rubio has cheered his proposals.

In the Senate, Rubio had long been a prominent voice on immigration and was a key member of a group that worked on a 2013 bill that included a path to citizenship for millions of people in the country illegally. Now, Rubio says he support’s Trump’s plan to deploy the U.S. military to deport those in the country illegally.

Doug Burgum

The North Dakota governor ran against Trump this year, but dropped out in December and endorsed Trump before voting began.

Before that, Burgum had rejected the idea of partnering with Trump.

In an interview last July on NBC’s “Meet the Press,” Burgum, a businessman, was asked if he would ever do business with Trump, and responded, “I don’t think so.” He added, “I just think that it’s important that you’re judged by the company you keep.”

The next month, he told CNN in an interview that he would not serve as Trump’s vice president.

Burgum this year has become an enthusiastic champion of Trump and has leveraged his profile as a wealthy businessman and governor versed in energy policy to help the Republican secure millions in fundraising, especially from high-dollar donors.

Elise Stefanik

When the New York congresswoman was first elected in 2014, she was known as a moderate Republican with ties to the party’s establishment.

In 2016, she initially supported Ohio Gov. John Kasich’s campaign. When Trump was the party’s nominee, she didn’t say his name, only saying she would “support my party’s nominee in the fall.”

She became a more vocal supporter as the election neared but made it clear she disagreed with him at times. Those disagreements faded over the years.

Stefanik emerged as one of Trump’s most outspoken defenders during his first impeachment in 2019, and it’s a role she’s embraced ever since. When Republicans ousted former Rep. Liz Cheney from leadership over her criticism of Trump and his efforts to overturn the 2020 election, it was Stefanik they chose to take her place.

Her loyalty to Trump stood out in 2022, as the former president’s esteem within the party had deflated after he was absorbing blame for weaker-than-expected results in the midterm elections. Stefanik announced days after the election that she was endorsing Trump for president in 2024 — an announcement that came before Trump even said he was running.

Tim Scott

In 2016, the South Carolina senator initially backed Rubio in the presidential race and excoriated Trump for his reluctance to condemn the Ku Klux Klan.

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“If Donald Trump can’t take a stand against the KKK, we cannot trust him to stand up for America against Putin, Iran or ISIS,” said Scott, the Senate’s only Black Republican.

Scott still supported Trump in the 2016 election against Democrat Hillary Clinton, calling him the “lesser of two evils.”

Scott also criticized Trump after his comments equivocating about the 2017 white nationalist rally in Charlottesville, Virginia, saying that his “moral authority” was “compromised.” He met with Trump at the White House after. In an interview on Fox News Channel on Thursday, Scott said that he shared his perspective with the then-president in that meeting and from then on they worked to “find solutions together.”

“It was the Charlottesville incident that made our relationship what it is today,” Scott said.

Though he ran against Trump in the 2024 GOP primary, Scott dropped out and has become one of his most enthusiastic cheerleaders.