In a snowy Wisconsin border town on Friday night, Pete Buttigieg, the smooth-talking former Biden administration official, exhorted a boisterous town hall crowd to pressure their Republican congressman on health care, condemning “savage cuts” to Medicaid and efforts to “obliterate” the Affordable Care Act.
A day later, Senator Cory Booker of New Jersey told a small crowd at a campaign stop in a converted cotton warehouse in rural South Carolina that it was “the height of cruelty that the richest nation in the world should not be able to afford basic health care for its people.”
The dual appearances were a preview of how Democrats — including some of the party’s most ambitious leaders and potential 2028 presidential candidates — plan to wield health care funding cuts as a cudgel against vulnerable Republicans in the fight to retake control of Congress this fall. Nearly every House and Senate Republican voted for President Trump’s sweeping domestic policy bill last summer, which included major cuts to Medicaid, and most of them opposed recent efforts to extend subsidies that made it cheaper for uninsured people to purchase health insurance.
“It seems to me that if Congressman Van Orden thinks that it is appropriate to slash Medicaid, to cut BadgerCare at a time like this when so many people are hurting, he would be willing to stand here and say why,” Mr. Buttigieg said, naming Derrick Van Orden, a vulnerable Republican who represents La Crosse, Wis., the college town on the edge of the Mississippi River and the Minnesota border where Mr. Buttigieg was speaking to a crowd of about 1,000.
The issue at the top of voters’ minds right now is immigration enforcement, as federal agents clash with protesters in Minneapolis after an Immigration and Customs Enforcement agent fatally shot a 37-year-old woman there this month. The ICE controversy lent an emotional undercurrent to Mr. Buttigieg’s rally, with several attendees crying during a question-and-answer session as they asked the former transportation secretary about the raids.
Mr. Buttigieg condemned “masked federal agents in tactical gear as if it was Fallujah on Midwestern city streets,” but also later told reporters that, unlike some Democrats, he did not support abolishing ICE.
“They need to be sent to do their actual job, which is not to control American neighborhoods as though they were war zones,” he said.
But health care was a close secondary issue, and one that could be an enduring concern if Democrats are able to tie it into broader anxieties over the economy and the cost of living, which polls have consistently suggested are top priorities for voters and a drag on Republicans.
Representative Alexandria Ocasio-Cortez, the high-profile New York Democrat whose name has also been floated as a possible 2028 presidential contender, sought this week to link the health-care funding cuts to the violent confrontations with ICE.
“Nearly $1 trillion in health care was taken out and given to ICE,” Ms. Ocasio-Cortez told reporters in Washington, referring to Medicaid cuts in Mr. Trump’s domestic policy bill last year. She also argued that additional funding for the agency had come at the expense of ACA subsidies. “So understand how these dots connect: You get screwed over to pay a bunch of thugs in the street that are shooting mothers in the face.”
Mr. Trump’s domestic policy bill allocated more money to immigration enforcement. The bill did not affect the subsidies included in the Affordable Care Act, also known as Obamacare, but it included major cuts to Medicaid and did not extend an enhanced version of the ACA subsidies that Congress passed in 2021 during the pandemic.
A Democratic proposal to extend those enhanced subsidies for three years, as well as an alternative Republican plan, both failed to advance in December, causing the subsidies to expire at the end of 2025. As health care premiums shot upward, a report this month found that 1.4 million fewer people had enrolled in Obamacare coverage this year.
A cohort of Republican House members in competitive re-election races — including Mr. Van Orden — broke with their colleagues this month, voting with Democrats to restore the enhanced subsidies. But Senate talks over such a bill have stalled.
The debate parallels the 2018 midterms, when Democrats highlighted Republican efforts to repeal the ACA and argued that Democrats would protect people with pre-existing health conditions if they regained control of Congress. The argument resonated, ushering in a blue wave that flipped control of the House. (House Democrats did pass legislation to help those with pre-existing conditions, but it went nowhere under Mr. Trump.)
Democrats are hoping for a similar backlash now. The Democratic Congressional Campaign Committee, which works to elect Democrats to the House, called out 18 Republicans in potentially competitive districts who did not vote to extend the subsidies, suggesting that they had just “told voters to kick them out of office in November.”
In La Crosse on Friday, Rebecca Cooke, a Democrat and businesswoman who lost to Mr. Van Orden in 2024 and is challenging him again, made the issue personal, telling the crowd that her father, after being diagnosed with prostate cancer, faced a $3,100 co-pay for the drugs he needed. Two television advertisements from an outside group aligned with Ms. Cooke’s campaign have hammered Mr. Van Orden over his health care votes.
“He has no idea what he wants for health care policy,” Ms. Cooke said in an interview. “It’s to repeal and replace Obamacare, but to replace it with what?”
Some Republicans have offered alternative proposals to lower health care costs, including Mr. Trump, who released a plan on Thursday that was light on specifics but called for redirecting subsidies into individual health savings accounts, allowing people to purchase health care services directly. Republicans have noted that the original ACA subsidies are still in place, and have argued that Democrats chose a 2025 end date for the enhanced subsidies when they passed the 2021 legislation.
“Democrats know their health care agenda has failed working families, so instead of owning it, they’re lying to voters,” Mike Marinella, a spokesman for the National Republican Congressional Committee, said in a statement. “Republicans are delivering real solutions to strengthen and protect care for vulnerable Americans, while Democrats fall back on scare tactics and spin.”
Mr. Van Orden, a second-term congressman and Navy SEAL veteran, faces a daunting re-election battle after winning by fewer than three percentage points in 2024. After voting to extend the enhanced subsidies this month, he told reporters that he still opposed the ACA but that he felt compelled to vote for a temporary remedy.
“Philosophically, I completely disagree with this,” he said. “But I’m not going to leave millions of Americans who truly need health care insurance in the lurch.”
On Friday, Mr. Van Orden’s campaign assailed Mr. Buttigieg’s visit to his district, saying the former mayor of South Bend, Ind., was “part of one of the worst administrations in American history.”
Mr. Buttigieg catapulted from a little-known Midwestern mayoralty to political stardom while running for president in 2020, winning accolades for his eloquence in debates.
Last year, he held a similar town hall event in Cedar Rapids, Iowa, fueling speculation about another presidential run. On Friday, asked again about whether he would run in 2028, Mr. Buttigieg demurred.
“I’m not going to make that kind of news or any kind of news here tonight,” he said.
Mr. Buttigieg brought a grimmer tone to La Crosse than he had in Cedar Rapids last year, lamenting the rising cost of living and the ICE raids.
“Things are not going well in the United States of America,” he said.
But he ended on an uplifting note, urging attendees to stay involved and suggesting that pressure from Wisconsinites had led to Mr. Van Orden’s reversal on the issue of health care subsidies.
“I know it feels bleak right now,” Mr. Buttigieg said. “We will get through this.”
That message resonated with Kathy Strong, 67, a retiree in La Crosse.
“I loved how he’s so positive,” she said. “And, I think, trying to make everybody own what they’ve got to do.”
In Estill, S.C., a town of 2,000, Mr. Booker spoke to a majority Black crowd of about 50, one of the stops on a tour of North and South Carolina. He focused on rising health care costs, criticizing Mr. Trump for tying Medicaid cuts to tax cuts for the wealthy in last year’s bill.
Berty Riley, 72, a social worker, said the Medicaid cuts had been frustrating and confounding for the seniors she works with, and she said she was heartened to hear Mr. Booker address the issue.
“I thought his speech was right on time,” she said.
Mr. Booker, who ran for president in 2020, said in an interview on Saturday that he was not yet considering another bid, but suggested he would eventually give “a lot of deep thought” to it. And he predicted peril for Republicans this fall.
“When it comes to health care in America, they’re very culpable for creating the reality in which we live,” Mr. Booker said, “and I think they’re going to pay a price at the polls unless we get something done together.”
Michael Gold contributed reporting from Washington.
Kellen Browning is a Times political reporter based in San Francisco.
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