Dancing at Birnamwood Polka Days, a festival in Birnamwood, Wisconsin.(Angela Hart/KFF Health News) Polka festivals are common across Wisconsin, especially in the summertime.(Angela Hart/KFF Health News) At Birnamwood Polka Days, candidates for local and state office often mingle with voters.(Angela Hart/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. Use Our Content

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At church picnics and summertime polka festivals that draw voters of all political stripes, Wisconsinites said theyre struggling to pay for even the most basic health care, from common blood tests to insulin prescriptions. A proposal by Wisconsins Democratic governor to expand the states Medicaid program to thousands of low-income residents has become a partisan lightning rod in the affordability debate: Democrats want it; Republicans dont.

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 years race. They were scheduled to square off tonight in the first televised debate of the campaign.

Many Wisconsin voters still cant figure out whom to vote for or whether to vote at all.

I know hes trying to improve health care and inflation, but Im 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. Bob Prelipp voted for Donald Trump in 2016, switched to Joe Biden in 2020, and is undecided about whom to vote for this year. I know hes trying to improve health care and inflation, but Im not happy with Biden, said Prelipp, a resident of Birnamwood, Wisconsin.(Angela Hart/KFF Health News)

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. 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 years race.(Angela Hart/KFF Health News)

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 cant 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. Greg Laabs, a musician playing at Birnamwood Polka Days, has a Trump sticker on his tuba. Laabs says he fears a Democratic president would provide publicly subsidized health care to immigrants without legal residency. There are thousands of people coming across the border, he says. We cannot support the whole world. (Angela Hart/KFF Health News) Email Sign-Up

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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 Bidens 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. Im seriously looking at alternatives. 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) Ron and Marie Knight own Knights Bar in the small town of Elderon, Wisconsin. They support former President Donald Trump, and even gave free cocktails to residents who voted for him in 2020. The issue of health care is important to them, they say, but the economy is their biggest concern.(Angela Hart/KFF Health News) We live on our credit cards and we max them out every month, says Veronica St. Clair. Her husband, Robert St. Clair, is a military veteran and says he wants to see the U.S. Department of Veterans Affairs privatized. Then maybe I wouldn’t have to fight with the VA to get medical treatment, he says.(Angela Hart/KFF Health News)

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.

She strongly supports Biden but said people are feeling squeezed. Were fortunate because we had some savings, but thats 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 dont have children, which all but 10 states have done since the enactment of Obamacare in 2010. The states 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. Wisconsin Gov. Tony Evers shakes hands with President Joe Biden after he arrives at Milwaukee Mitchell International Airport on May 8.(Mandel Ngan/AFP via Getty Images)

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 ad 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.

Bidens campaign is opening field offices in Wisconsin, and he and federal health care officials make frequent visits to the state. Theyre touting Bidens 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. Thats not an accident.

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. 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.(Angela Hart/KFF Health News)

We had a hospital thats 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. Its 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 youre always expanding government programs, you get people hooked on government and they dont 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. Cory Sillars, a Republican candidate for the Wisconsin State Assembly, attends Birnamwood Polka Days to campaign and watch a parade.(Angela Hart/KFF Health News)

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 states 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 theyre having conversations about it, and theyre going to vote on it.

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

Angela Hart: ahart@kff.org, @ahartreports Related Topics Elections Health Care Costs Health Care Reform Health Industry Medicaid Medicare Rural Health States Wisconsin Contact Us Submit a Story Tip