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    Elizabeth Warren: Don’t Be Fooled. Donald Trump Has a Plan.

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    During the presidential debate on Tuesday, Donald Trump was pressed on the details of his plan to repeal Obamacare and replace it with something “better.” The question should’ve been a softball. After all, Mr. Trump has been promising the American people a plan for nine years, so he’s had time to prepare. His answer? After ducking and weaving, he came up with: “I have concepts of a plan.” Uh, that’s not a plan.Plans translate values into action. They test the quality of the ideas and the seriousness of the people advancing them. Plans reveal for whom candidates will fight and how effective they are likely to be. And in a presidential race, if either party’s nominee is asked about his or her plans for something as fundamental as health care, voters should get a straight answer.The problem is not that Mr. Trump can’t think up a way to put his values into action. The problem is that when he and other Republican leaders produce plans with actual details, they horrify the American people.Mr. Trump’s health care values have been on full display for years. In 2017, Republicans controlled Congress, and their first major legislative undertaking was a bill to repeal the Affordable Care Act. Every time they drafted something, independent experts would point out that their plan would toss tens of millions of people off their health insurance, jack up premium costs and slash benefits for those with ongoing health problems.After months of wrangling, Mr. Trump and Republican lawmakers voted a bill through the House to repeal the A.C.A. That night, Mr. Trump hosted a party at the White House to celebrate their big step toward taking away health care from millions of people.A.C.A. repeal then moved to the Senate. Republicans had the majority, so if they all stuck with Mr. Trump, the A.C.A. would die. As senators gathered to vote, nearly all of the Democrats — including Kamala Harris, then a senator from California — remained standing, too anxious even to sit down. We murmured stories about who would be affected by this vote: the uncle who had cancer and would lose coverage, the kid diagnosed with a heart anomaly whose parents wouldn’t be able to find new insurance, the college students who would just go without coverage and hope they didn’t fall on ice or get in a car accident. We felt the weight of people’s lives on the line.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Young Americans Can’t Keep Funding Boomers and Beyond

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      You know the expression “OK, Boomer”? Better said as “Boomer OK.” That’s because the social safety net in the United States is increasingly favoring the old over the young. And this affects our political views and the security of future generations.Younger Americans have valid reason for disgruntlement: Big shifts in income and wealth are dramatically favoring their elders. Under almost every president since 1980, 80 percent of the real growth in domestic spending has gone to Social Security and health care, with Medicare the most expensive health program, according to calculations based on federal data. As a share of GDP, all other domestic outlays combined have declined.Our current tax system also largely does not help Americans, most of whom are younger, pay for their higher education. That wasn’t as big a deal in the 1960s or 1970s, when the average college graduate most likely had little or no student debt. Today, the average taken out each year is about seven times that in 1971, in part because state governments have stripped colleges and universities of funding. This is happening at a time when owning a house is increasingly out of reach. The median price has risen from about 3.5 times median annual income in 1984 to 5.8 times in 2022.So it shouldn’t come as a surprise that today, younger generations are more likely to fall into lower-income classes than their parents or grandparents. Nearly a half century ago, it was the reverse. And in 1989, the median net worth of Americans aged 35 to 44 was nearly 75 percent of those aged 65 to 74. By 2022, that ratio had fallen to one-third.The why is simple. Unlike most other spending, Congress effectively designed Medicare in 1965 and Social Security in the 1970s in such a way that outlays would increase forever faster than our national income. That’s partly because Medicare costs keep rising along with medical prices and new treatments and because Social Security benefits are designed to increase for each new generation along with inflation and wages. And we’re living longer, which means more years of benefits.Today, tax revenues are so committed to mandatory spending, largely for older Americans, and to interest on the national debt (which has quadrupled as a share of G.D.P. since 1980) that few revenues are left for everything else. So, unless we borrow to pay for it, there’s little for education, infrastructure, environment, affordable housing, reducing poverty, or the military.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Fact-Checking Trump and Others’ Sparring Over Social Security and Medicare

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      The top presidential candidates are vowing to protect the entitlement programs for current seniors, though some have floated changes for younger generations. But they’ve muddied each other’s current positions.Top contenders for the 2024 presidential election in recent weeks have accused each other of jeopardizing Social Security and Medicare, key entitlement programs for seniors.The future of the programs has been fodder for endless political debate — and distortions — because of the long-term financial challenges they face.Social Security’s main trust fund is currently projected to be depleted in 2033, meaning the program would then be able to pay only about three-quarters of total scheduled benefits. Medicare, for its part, is at risk of not having enough money to fully pay hospitals by 2031.President Biden, former President Donald J. Trump, Nikki Haley, the former governor of South Carolina, and Gov. Ron DeSantis of Florida are among the candidates zeroing in on those vulnerabilities, often by referring to one another’s previous positions.Here’s a fact-check.WHAT WAS SAID“Trump in 2020: We will be cutting Social Security and Medicare”— Biden campaign in a December social media post that includes a clip of Mr. TrumpThis is misleading. The Biden campaign has repeatedly claimed that cutting the programs is one of Mr. Trump’s policies. But while Mr. Trump has in the past suggested he might entertain trims to entitlements, he has repeatedly vowed during his campaign to protect the programs.In this case, the Biden campaign shared a short clip of Mr. Trump during a Fox News town hall in March 2020 and ignored his clarification at the time.The clip shows a Fox News host, Martha MacCallum, telling Mr. Trump, “If you don’t cut something in entitlements, you’ll never really deal with the debt.”“Oh, we’ll be cutting, but we’re also going to have growth like you’ve never had before,” Mr. Trump responded.The Trump administration immediately walked back his comments and said he was referring to cutting deficits. “I will protect your Social Security and Medicare, just as I have for the past 3 years,” Mr. Trump wrote in a post a day later.During his time in office, Mr. Trump did propose some cuts to Medicare — though experts said the cost reductions would not have significantly affected benefits — and to Social Security’s programs for people with disabilities. They were not enacted by Congress.Like other candidates, including Mr. Biden, Mr. Trump has shifted his positions over time. In a 2000 book, Mr. Trump suggested, for people under 40, raising the age for receiving full Social Security retirement benefits to 70. Before that, he said he was open to the idea of privatizing the program, even if he did not like the concept. He no longer advances those positions.Former President Donald J. Trump suggested that the government could avert Social Security changes by expanding drilling, but experts say that would not be enough revenue.Doug Mills/The New York TimesLast January, the former president said in a video that “under no circumstances should Republicans vote to cut a single penny from Medicare or Social Security.” But he has not outlined a clear plan for keeping the programs solvent. The Trump campaign did not respond to a request for comment.Mr. Trump suggested last month that the government could avert any Social Security changes by expanding drilling in the United States, but experts say that is not feasible.“Dedicating current oil and gas leasing revenues to Social Security would cover less than 4 percent of its shortfall, and it would be impossible to fix Social Security even if all federal land were opened to drilling operations,” according to the Committee for a Responsible Federal Budget.WHAT WAS SAID“And unlike Ron DeSanctimonious, we will always protect Social Security and Medicare for our great seniors. He wanted to knock the hell out of Social Security and Medicare.”— Mr. Trump during a campaign rally in mid-DecemberThis is misleading. While in Congress, Mr. DeSantis supported budget frameworks that proposed raising the full Social Security retirement age to 70, but leaving the early retirement age the same. As a presidential candidate, he has said he would not cut Social Security for seniors but has at times expressed openness to changes for younger people without specifying what those are.Currently, workers are eligible for their full benefits at their full retirement age, which varies from 66 to 67 depending on year of birth. But recipients can qualify for reduced benefits as early as age 62.As a Florida congressman, Mr. DeSantis did vote for Republican budget proposals — which would not have changed the law on their own — that supported gradually raising the full retirement age for Social Security to 70. The proposals did not call for changing the early retirement age.Gov. Ron DeSantis has not made clear his plans for Medicare as he runs for president.Rachel Mummey for The New York TimesThe proposals also called for changes to Medicare, including by eventually increasing its retirement age to 67 or 70, from 65, and transitioning the program to “premium support,” in which the government would provide payments for seniors to shop for various health care plans.Mr. DeSantis has not made clear his plans for Medicare as he runs for president, but he has often rejected the idea of changing Social Security. “We’re not going to mess with Social Security as Republicans, I think that that’s pretty clear,” he said in March.That said, he has signaled openness to adjusting the program for younger people. In a July interview on Fox News, Mr. DeSantis said, “Talking about making changes for people in their 30s or 40s, so that the program’s viable, you know, that’s a much different thing, and that’s something that I think there’s going to need to be discussions on.”The DeSantis campaign did not respond to a request for comment.WHAT WAS SAID“Nikki Haley, she has claimed that the retirement age is way, way, way too low. That’s what she said. So you’ve got a lot of people that have worked hard their whole life. Life expectancy is declining in this country. It’s tragic, but it’s true. So to look at those demographic trends and say that you would jack it up so that people are not going to be able to have benefits. I mean, I don’t know why she’s saying that.”— Mr. DeSantis on CNN last monthThis needs context. Life expectancy in the United States dropped during the coronavirus pandemic, but it is inching back up. And Ms. Haley has only called for changes to Social Security for younger people — not unlike what Mr. DeSantis himself has entertained.“The way we deal with it is, we don’t touch anyone’s retirement or anyone who’s been promised in, but we go to people, like my kids in their 20s, when they’re coming into the system, and we say, ‘The rules have changed,’” Ms. Haley said in an August interview with Bloomberg. “We change retirement age to reflect life expectancy.”Ms. Haley did not specify what the new retirement age should be. “What we do know is 65 is way too low, and we need to increase that,” she said when pressed. “We need to do it according to life expectancy.”Nikki Haley has suggested changing the Social Security retirement age for younger generations.Jordan Gale for The New York TimesMs. Haley also called for determining benefit adjustments based on inflation, rather than the current cost-of-living calculation, and limiting benefits for the wealthy.On Medicare, Ms. Haley has proposed expanding Medicare Advantage, under which private companies provide plans and are paid by the government to cover the beneficiary.Yet for 2023, the government was projected to spend $27 billion more for Medicare Advantage plans than if those enrollees were in traditional Medicare. Experts note that expanding Medicare Advantage while achieving overall savings would require structural changes that would be politically challenging to implement.“It would require a change in payment policy that would likely run into fierce opposition,” said Tricia Neuman, senior vice president at the health nonprofit KFF and executive director for its program on Medicare policy.Curious about the accuracy of a claim? Email factcheck@nytimes.com. More

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      The G.O.P. Goes Full-on Extremist

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      There are no moderate Republicans in the House of Representatives.Oh, no doubt some members are privately appalled by the views of Mike Johnson, the new speaker. But what they think in the privacy of their own minds isn’t important. What matters is what they do — and every single one of them went along with the selection of a radical extremist.In fact, Johnson is more extreme than most people, I think even political reporters, fully realize.Much of the reporting on Johnson has, understandably, focused on his role in the efforts to overturn the 2020 election. Let me say, by the way, that the widely used term “election denial” is a euphemism that softens and blurs what we’re really talking about. Trying to keep your party in power after it lost a free and fair election, without a shred of evidence of significant fraud, isn’t just denial; it’s a betrayal of democracy.There has also been considerable coverage of Johnson’s right-wing social views, but I’m not sure how many people grasp the depth of his intolerance. Johnson isn’t just someone who wants to legalize discrimination against L.G.B.T.Q. Americans and ban gay marriage; he’s on record as defending the criminalization of gay sex.But Johnson’s extremism, and that of the party that chose him, goes beyond rejecting democracy and trying to turn back the clock on decades of social progress. He has also espoused a startlingly reactionary economic agenda.Until his sudden elevation to speaker, Johnson was a relatively little-known figure. But he did serve for a time as chairman of the Republican Study Committee, a group that devises policy proposals. And now that Johnson has become the face of his party, people really should look at the budget proposal the committee released for 2020 under his chairmanship.For if you read that proposal carefully, getting past the often mealy-mouthed language, you realize that it calls for the evisceration of the U.S. social safety net — not just programs for the poor, but also policies that form the bedrock of financial stability for the American middle class.Start with Social Security, where the budget calls for raising the retirement age — already set to rise to 67 — to 69 or 70, with possible further increases as life expectancy rises.On the surface, this might sound plausible. Until Covid produced a huge drop, average U.S. life expectancy at age 65 was steadily rising over time. But there is a huge and growing gap between the number of years affluent Americans can expect to live and life expectancy for lower-income groups, including not just the poor but also much of the working class. So raising the retirement age would fall hard on less fortunate Americans — precisely the people who depend most on Social Security.Then there’s Medicare, for which the budget proposes increasing the eligibility age “so it is aligned with the normal retirement age for Social Security and then indexing this age to life expectancy.” Translation: Raise the Medicare age from 65 to 70, then keep raising it.Wait, there’s more. Most nonelderly Americans receive health insurance through their employers. But this system depends greatly on policies that the study committee proposed eliminating. You see, benefits don’t count as taxable income — but in order to maintain this tax advantage, companies (roughly speaking) must cover all their employees, as opposed to offering benefits only to highly compensated individuals.The committee budget would eliminate this incentive for broad coverage by limiting the tax deduction for employer benefits and offering the same deduction for insurance purchased by individuals. As a result, some employers would probably just give their top earners cash, which they could use to buy expensive individual plans, while dropping coverage for the rest of their workers.Oh, and it goes almost without saying that the budget would impose savage cuts — $3 trillion over a decade — on Medicaid, children’s health coverage and subsidies that help lower-income Americans afford insurance under the Affordable Care Act.How many Americans would lose health insurance under these proposals? Back in 2017 the Congressional Budget Office estimated that Donald Trump’s attempt to repeal Obamacare would cause 23 million Americans to lose coverage. The Republican Study Committee’s proposals are far more draconian and far-reaching, so the losses would presumably be much bigger.So Mike Johnson is on record advocating policies on retirement, health care and other areas I don’t have space to get into, like food stamps, that would basically end American society as we know it. We would become a vastly crueler and less secure nation, with far more sheer misery.I think it’s safe to say that these proposals would be hugely unpopular — if voters knew about them. But will they?Actually, I’d like to see some focus groups asking what Americans think of Johnson’s policy positions. Here’s my guess, based on previous experience: Many voters will simply refuse to believe that prominent Republicans, let alone the speaker of the House, are really advocating such terrible things.But they are and he is. The G.O.P. has gone full-on extremist, on economic as well as social issues. The question now is whether the American public will notice.The Times is committed to publishing a diversity of letters to the editor. We’d like to hear what you think about this or any of our articles. Here are some tips. And here’s our email: letters@nytimes.com.Follow The New York Times Opinion section on Facebook, Twitter (@NYTopinion) and Instagram. More

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      Biden Makes Lower Drug Prices a Centerpiece of His 2024 Campaign

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      President Biden’s Inflation Reduction Act allows Medicare to negotiate some drug prices, a change that the pharmaceutical industry and Republicans have opposed for decades.As he heads toward a re-election campaign next year, President Biden is betting that his success in pushing for policies intended to lower health care costs for millions of Americans will be rewarded by voters at the ballot box.In speech after speech, Mr. Biden talks about capping the cost of insulin at $35, putting new limits on medical expenses for seniors, making some vaccines free and pushing to lower the prices of some of the most expensive drugs in the world.At the White House, Mr. Biden and his advisers have already begun to elevate the issue as a centerpiece of his agenda. And at his campaign headquarters in Wilmington, Del., aides are preparing television ads, talking points and speeches arguing that Mr. Biden’s push for lower health care costs is a stark contrast with his Republican opponents.“The president will have a very strong case to make,” said Senator Amy Klobuchar of Minnesota, a member of the president’s national campaign advisory board. “Not only will people want to keep the benefits they have seen, they are going to want to get the benefits that are coming their way.”On Tuesday, the White House announced that the Biden administration will negotiate on behalf of Medicare recipients for lower prices on 10 popular — and expensive — drugs that are used to treat diabetes, heart disease and other chronic illnesses.The move was made possible by passage last year of Mr. Biden’s Inflation Reduction Act, which for the first time allows Medicare to negotiate drug prices for older adults, a change that has been opposed by the pharmaceutical industry for decades.Republicans also generally oppose giving the government the right to negotiate drug prices. But the candidates for the Republican presidential nomination have said little about the cost of medication, focusing instead on abortion, transgender medical issues and Covid lockdowns.In his speeches, Mr. Biden rails against the industry and his Republican adversaries in Congress, all of whom voted against the law that included the prescription drug provisions. Aides say it is an effective message.“Today is the start of a new deal for patients where Big Pharma doesn’t just get a blank check at your expense,” the president said at a White House event celebrating the change.Since signing the law a year ago, Mr. Biden has repeatedly called it one of his proudest legislative victories. But his approval numbers have hardly budged. And while polls show that the new policy is widely popular among Americans who know about it, they also suggest that far fewer people are even aware that the change was made.That is most likely because prices on just the first handful of drugs are not scheduled to actually drop until 2026 at the earliest, assuming Mr. Biden’s program survives legal challenges. Drug companies have filed numerous lawsuits against the administration that claim the law is unconstitutional. Court cases could drag on for years.In its lawsuit against the administration, the Pharmaceutical Research and Manufacturers of America, an industry trade group, called the plan for negotiated prices “a government mandate disguised as negotiation.”Even if Mr. Biden’s plan goes into effect, older adults who have made the choice to ration their drugs will have to continue doing so until more than a year after the 2024 presidential election.Danny Cottrell, 67, a pharmacist who owns his retail pharmacy group in Brewton, Ala., said he regularly advised his Medicare patients on the ins and outs of the government’s prescription program. He welcomed Mr. Biden’s changes, but said it would be up to people like him to explain the complicated process.“I got to remind them, this doesn’t start till 2026,” Mr. Cottrell said. “And then also remind them this thing will change several times between now and then.”Neera Tanden, Mr. Biden’s top domestic policy adviser, said the White House was confident that the plan would survive the legal challenges.“It is absurd to argue that negotiation is unconstitutional,” she said in an interview. “There’s nothing in the Constitution that says Medicare negotiating drug prices is unconstitutional.”But more broadly, Ms. Tanden said that she and the president’s other advisers in the West Wing were determined to make the push for lower health care costs a central part of Mr. Biden’s message to Americans.And next September, just weeks before Election Day, the administration will announce the results of the yearlong negotiations over the first 10 drugs.“We plan to work extensively, to really remind folks of this issue,” Ms. Tanden said.For the people leading Mr. Biden’s re-election campaign, the political benefits of focusing on lower health care costs are clear.Some polls show that 80 percent of Americans support giving the government the ability to negotiate lower prices for Medicare, much the way it already does for veterans and members of the military.Campaign aides said talking about lower costs of drugs or limits on out-of-pocket medical expenses is one way to help Mr. Biden win support among seniors, who traditionally have voted for Republicans in greater numbers. That is especially important in battleground states like Michigan, Arizona, Georgia and Ohio, where increasing support among older adults will be critical in close contests.The campaign’s early television ads have included numerous references to the president’s efforts to lower health care costs. A spokesman for the campaign said the issue of health care would be a central feature of a $25 million ad blitz focusing on what the president has done to lower costs overall and make economic progress.Kate Bedingfield, who served as Mr. Biden’s communications director for the first two years of his presidency, said the issue had political benefits even when it came to appealing to people who do not benefit directly from the specific cost reductions.“It draws a really clear contrast with the Republicans, who have stood in the way and continue to stand in the way of getting more done on this,” she said.Representative Michael C. Burgess, Republican of Texas and a doctor, said Mr. Biden’s drug price negotiations were akin to government-imposed price controls that would lead to drug shortages.“This administration’s approach goes beyond ‘negotiation,’” he said in a statement. “Instead, it holds pharmaceutical companies hostage, jeopardizing their future innovation and the well-being of American patients.”Mr. Biden’s campaign aides said a debate with Republicans about the cost of medical care was one they were eager to have.“MAGA Republicans running for president want to repeal the Inflation Reduction Act, which would deliver a massive win for Big Pharma and increase costs for the American people,” said Julie Chávez Rodríguez, the president’s campaign manager, referring to Republicans loyal to former President Donald J. Trump.She said the choice in the election was between Mr. Biden and “a slate of candidates focused on extreme policies that put their wealthy donors first.”Robert Jimison More

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      Fact-Checking Mike Pence on the Campaign Trail

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      The former vice president has made misleading claims about abortion, fiscal policy and military spending.Since beginning his long-shot presidential campaign in June, former Vice President Mike Pence has struggled to gain traction among Republican primary voters.Mr. Pence has consistently polled in the single digits behind the two leading contenders: his onetime running mate, former President Donald J. Trump, and Gov. Ron DeSantis of Florida. The former vice president has broken with them most starkly on their approaches to Social Security and Medicare. He has also carved out clear positions supporting a 15-week national abortion ban and wholeheartedly backing American involvement in the war in Ukraine.Mr. Pence has made some inaccurate claims along the way. Here’s a fact check of some of his recent remarks on the campaign trail.AbortionWhat Mr. Pence Said“I did, this week, call on every other candidate for the Republican nomination to support a minimum standard of a 15-week ban on abortion at the national level that would align American law with most of the countries in Europe that literally ban abortion after 12 to 15 weeks. Our laws at the national level today are more aligned with North Korea, China and Iran than with other Western countries in Europe.”— in a June interview on Fox News SundayThis is misleading. Mr. Pence’s comparison is overly simplistic and glosses over how abortion laws in Europe work in practice. It is also worth noting that many European countries are moving toward relaxing abortion restrictions, not imposing additional ones, as The Upshot has reported.Of some four dozen countries in Europe, almost all have legalized elective abortion before 10 to 15 weeks of pregnancy. All of these countries allow abortions after the gestational limit if the mother’s life is in danger and about half do so for cases involving sexual violence — two exceptions that Mr. Pence has said he also supports. But many also allow for broader exceptions, like the socioeconomic circumstances or mental health of the mother, which Mr. Pence’s proposal does not include.In Britain, for example, an abortion must be approved by two doctors, but those requests are generally granted up to 24 weeks. In Denmark and Germany, exceptions for gestational limits of 12 weeks are made for mental and physical health as well as living conditions.At least three countries also have more permissive gestational cutoffs than Mr. Pence’s proposal: Iceland at 22 weeks, the Netherlands at 24 weeks and Sweden at 18 weeks.In contrast, China allows elective abortions without specifying gestational limits in its national laws, according to the World Health Organization. China also has said in recent years that it will aim to reduce the number of “medically unnecessary” abortions, and at least one province has prohibited abortions after 14 weeks.North Korea’s laws on abortion are unclear. In 2015, the authorities issued a directive barring doctors from performing abortions, according to the World Health Organization, but “there are no documents after 2015” on the legality of the procedure.In the United States, after the Supreme Court eliminated the constitutional right to an abortion last summer, the legal status of abortion varies widely from state to state. In some, the procedure is banned with no exceptions, and in others it is enshrined as a right with no gestational limits. A spokesman for Mr. Pence cited nine such states as exceptionally nonrestrictive.Fiscal policyWhat Mr. Pence Said“Well, first off, look, Joe Biden’s policy on our national debt is insolvency. And, sadly, my former running mate’s policy is identical to Joe Biden’s. Both of them say they’re not even going to talk about common sense and compassionate reforms to entitlements to spare future generations of a mountain range of debt.”— in the Fox News Sunday interviewThis is exaggerated. Asked about his calls to overhaul Social Security and Medicare, Mr. Pence criticized Mr. Trump’s and Mr. Biden’s approaches to the social programs as irresponsible. While both have said they would not cut benefits, only Mr. Biden has proposed tax increases to shore up both programs. But equating that position to one of accepting total insolvency is overstated.Currently, Social Security and Medicare both face financial shortfalls. The fund that pays for Social Security retirement benefits is projected to be depleted by 2033, and the fund that pays hospitals for Medicare patients will be exhausted in 2031. At those points, the funds will be able to pay for only 77 percent of retirement benefits and 89 percent of scheduled fees to hospitals.During the 2020 campaign, Mr. Biden proposed increasing taxes on high-income earners to pay for additional Social Security benefits. The extra funding would reduce the program’s financial shortfall, though the revenue would not close the gap entirely. While his latest presidential budget, released in March, does not mention that proposal, it does include a plan to extend the solvency of Medicare by 25 years by imposing higher taxes on the wealthy.Mr. Trump’s position on social safety net programs is a bit harder to pin down. In January 2020, he said he would be willing to consider cuts to the social safety nets “at some point” — though he quickly tried to walk back his comments and vowed to protect Social Security. His last presidential budget proposal, in February 2020, did not cut benefits to either program, but sought Medicare savings through a dozen tweaks like reducing payments to providers and reducing the cost of prescription drugs.More recently, Mr. Trump vowed in a speech in March at the Conservative Political Action Conference that “we are never going back” to proposals to raise the Social Security retirement age or cut Medicare benefits. But Mr. Trump has not yet outlined his stance on either program in more detail or addressed their solvency issues in this campaign cycle.The Pence campaign argued that neither Mr. Trump nor Mr. Biden has a current plan for Social Security, and that Mr. Biden’s plan for Medicare just delays the financial shortfall.Mr. Pence has made misleading claims about abortion, fiscal policy and military spending.Jordan Gale for The New York TimesClassified documentsWhat Mr. Pence Said“I mean, when I informed the Department of Justice that we had classified materials potentially in our home, they were at my home. The F.B.I. was on my front doorstep the next day. And what we found out was that, when Joe Biden apparently alerted the Department of Justice, 80 days later, they showed up at his office.”— in a CNN town hall in JuneThis is exaggerated. Upon the discovery of classified documents in their personal residences, Mr. Pence and Mr. Biden both cooperated with government inquiries. Mr. Pence has a point that the Justice Department’s responses to the discoveries were not identical, but he is overstating the differences.In Mr. Biden’s case, the searches occurred a few weeks — not three months — after the discovery of classified documents. In Mr. Pence’s case, the search occurred about three weeks later.On Nov. 2, lawyers for Mr. Biden discovered classified documents at the offices of the Penn Biden Center for Diplomacy and Global Engagement, a think tank in Washington. On the same day, according to Biden administration officials, the lawyers alerted the National Archives and Records Administration, which is responsible for securing such documents. The next day, the National Archives retrieved the documents and referred the matter to the Justice Department. The F.B.I. searched the think tank in mid-November.On Dec. 20, Mr. Biden’s aides discovered a second set of classified documents at his home in Wilmington, Del. The same day, they alerted the U.S. attorney leading the investigation about the discovery. A month later, on Jan. 20, the F.B.I. searched the residence and seized additional documents. And on Feb. 1, the F.B.I. searched Mr. Biden’s vacation home in Rehoboth Beach, Del., but did not find additional classified documents.The discovery of classified documents in Mr. Biden’s possession prompted aides for Mr. Pence to search his home in Indiana out of caution. They found about a dozen documents with classified markings on Jan. 16 and alerted the National Archives to the discovery in a letter dated Jan. 18. The Justice Department, rather than the records agency, then retrieved the documents from Mr. Pence’s home on Jan. 19. Nearly a month later, on Feb. 10, the F.B.I. searched Mr. Pence’s home and found one additional document.The Pence campaign argued that the Justice Department, in directly requesting the documents from Mr. Pence, bypassed the standard procedures, which did not occur in Mr. Biden’s case.Unlike the Biden and Trump cases, Attorney General Merrick B. Garland did not appoint a special counsel to investigate Mr. Pence’s handling of classified materials. The Justice Department has also declined to prosecute Mr. Pence while the inquiry into Mr. Biden remains ongoing.Funding for the militaryWhat Mr. Pence Said“Since Joe Biden took office, he’s been working to cut military spending.”— at the Family Leadership Summit in Iowa in JulyThis is false. Mr. Biden’s annual budgets have generally asked for more funding for the military, and actual spending has increased each year.Mr. Biden’s first budget, released in 2021, proposed $715 billion for the Pentagon, essentially keeping funding level. That was a 1.6 percent increase from the previous year and a 0.4 percent decrease when adjusted for inflation. In December of that year, he signed into law a $770 billion defense package.After Russia invaded Ukraine in February 2022, Mr. Biden’s proposals and congressional appropriators amped up military spending even more.The budget he released in 2022 requested $773 billion in military spending, a nearly 10 percent increase from the previous year. He eventually signed into law an $858 billion spending policy bill.And Mr. Biden’s latest budget, released in March, asked for $842 billion for the military, a 3.2 percent increase from the previous year, and $886 billion total for national defense. That legislation is currently going through the appropriations process in Congress. The Pence campaign argued that this amounted to a cut, as the rate of inflation outstrips the rate of increase.At the Iowa event, Mr. Pence cited Mr. Biden’s debt ceiling deal with House Speaker Kevin McCarthy as an example of a proposed 1 percent cut to the military. Under that deal, military spending is set at the president’s proposed amount of $886 billion and would rise to $895 billion in 2025. But all spending, for both the military and domestic programs, would be subject to a 1 percent cut if Congress does not pass annual spending bills by January.We welcome suggestions and tips from readers on what to fact-check on email and Twitter. More

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      The G.O.P.’s Fiscal Hawks Fly Far Away From Deficit Fights

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      After a decade of rising deficits and soaring debt, the top White House contenders, Donald Trump and Ron DeSantis, show little interest in battling over the nation’s finances.The first skirmish of the Republican presidential primary of 2024 broke through this weekend. It was not over a traditional theme of conservative politics, such as national defense, or more contemporary issues like immigration or “woke” social policy.Instead, the political organizations of former President Donald J. Trump and Gov. Ron DeSantis of Florida put their candidates forward as the guardians of the Democratic Party’s most precious policy legacies: Social Security and Medicare.The jousting between Mr. Trump, the front-runner for the Republican nomination, and Mr. DeSantis, his undeclared and closest rival, signaled that after a decade of rising deficits, soaring debt and political silence from both parties, any grappling with the nation’s worsening fiscal condition will not be shaped by the Republican White House contenders. The party that once prided itself on cleareyed fiscal truth-telling — a message marred, without doubt, by successive tax-cutting — is still having none of it.And that signal came at a most inopportune moment, as House Republican leaders are girding for a fight over the government’s borrowing limit, linking any increase in the debt ceiling with tough spending cuts that the leaders of the party in 2024 show no interest in.“The facts are still on our side, and history is on our side,” said Douglas Holtz-Eakin, a former director of the Congressional Budget Office who guided the fiscal policies of John McCain’s 2008 presidential campaign. “It’s just a bad era.”There was nothing particularly Republican in the exchange of advertisements posted by the super PACs of Mr. Trump and Mr. DeSantis. On Friday, Make America Great Again Inc., a Trump-aligned political action committee, started running an advertisement declaring, “DeSantis has his dirty fingers all over senior entitlements, like cutting Medicare, slashing Social Security, even raising our retirement age.”The DeSantis-linked Never Back Down PAC responded by accusing Mr. Trump of “repeating lies about Social Security,” then showed Mr. DeSantis saying, “We’re not going to mess with Social Security as Republicans.”With that backdrop, Speaker Kevin McCarthy of California went on Monday to the New York Stock Exchange to try to prod President Biden into negotiations on the deficit, telling leaders in finance, “I want to talk to you about the debate that is not happening in Washington but should be happening over our national debt,” then adding, “America deserves to hear the truth.”The Republican House speaker, Kevin McCarthy, on Monday at the New York Stock Exchange.Jeenah Moon for The New York TimesThe problem with that truth is the math: With Republicans vowing once again not to raise taxes, exempting Social Security and Medicare from spending cuts would mean everything else funded by the federal government — the military, veterans’ programs, Medicaid, medical research, education, energy development — would need to be cut by 52 percent to balance the budget by 2033, according to the Committee for a Responsible Federal Budget, a nonpartisan research and advocacy group that is highly critical of both parties.If the Social Security and Medicare exemption was extended to the military at a time when Republicans want to confront the threat from China, everything else needs to be cut by 70 percent. If veterans’ programs were also protected, Medicaid and a host of other programs — food stamps, NASA, the National Institutes of Health, agricultural subsidies, food safety inspections, federal student aid, air traffic controllers, weather forecasters, National Parks, health care for the poor and self-employed, and much more — would need to be cut by 78 percent.“It used to be that everybody fought for political giveaways, but in the end, everybody knew the truth, so there was room for trade-offs and hard compromises,” said Maya MacGuineas, the president of the Committee for a Responsible Federal Budget. “There is no good, hard governance anymore.”It has been just over a decade since Mitt Romney, the Republican presidential nominee, selected as his running mate the party’s embodiment of hair-shirt policymaking, Paul D. Ryan. At the time, then-Representative Ryan did not flinch in his assertions that the retiring baby boom generation made benefit cuts to Social Security and Medicare absolutely vital to the nation’s future.And as a House member a decade ago, Mr. DeSantis readily embraced what was then the mainstream Republican position, voting repeatedly for Ryan-style changes to Social Security and Medicare that went nowhere, and promoting the restructuring of entitlements to make them “sustainable over the long term.”But in the loss of the Romney-Ryan ticket in 2012, Mr. Trump saw a lesson for his own presidential aspirations. And four years later, the business executive and reality television star ran on the improbable pledge to balance the budget, pay off the entire federal debt and never ever cut Social Security and Medicare.Paul Ryan and Mitt Romney on their way to a rally in Denver in 2012.Stephen Crowley/The New York Times“Trump figured out in 2016 that an older, more working class, more populist party would become increasingly against fixing Social Security and Medicare, and he was right,” said Brian Riedl, who served as a budget adviser to former Senator Rob Portman of Ohio and is now a senior fellow at the conservative Manhattan Institute. “It’s clearly good politics to recast yourself as the defender of Social Security and Medicare. It’s just bad for the country.”Deficits rose every year of the Trump presidency, from the $590 billion he inherited in the 2016 fiscal year, to $670 billion in 2017, $780 billion in 2018, $980 billion the following year, then a staggering $3.13 trillion in the pandemic year of 2020. By Mr. Riedl’s calculations, Mr. Trump added $7.8 trillion in deficit spending over 10 years through legislation and executive orders during his four years.That Mr. Trump fulfilled none of his promises of fiscal rectitude did not seem to matter; fiscal policy hardly came up during the campaign of 2020 and has not exactly reverberated in the Biden years either.“Neither Donald Trump nor Joe Biden has shown any interest in disciplining spending,” said Judd Gregg, a Republican and former New Hampshire senator who made a career of pushing for long-term deficit reduction. “But inevitably this comes to an end at some point — a herd of elephants coming over the horizon.”The herd is coming in two forms. The first is the aging baby boom generation, which is already driving up Social Security and Medicare costs. The number of Social Security recipients will rise from 44 million in 2010 to 73 million in 2030, raising Social Security spending from 4.8 percent of the economy to 5.9 percent.The second is interest on the national debt, which must cover interest rates that are rising after years of rock-bottom prices, driving up the cost of serving the government’s $31 trillion debt. After steep declines in the 2021 and 2022 fiscal years that Mr. Biden bragged about on Tuesday, the federal deficit in the first half of 2023 reached $1.1 trillion, according to the Congressional Budget Office, up $430 billion from the first half of the previous fiscal year. Interest payments rose from $219 billion to $308 billion, a 41 percent leap that put debt servicing nearly on par with military spending.“You can’t have interest payments that are higher than defense payments, yet that’s the track we’re on in the next five years,” Ms. MacGuineas said. “We’re the frog in the boiling water.” More

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      in Elections

      Obamacare Keeps Winning

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      Its North Carolina victory is a sign of larger changes.The government benefits began their existence as objects of partisan rancor and harsh criticism. Eventually, though, they became so popular that politicians of both parties promised to protect them.It was true of Social Security and Medicare. And now the pattern seems to be repeating itself with Obamacare.Consider what has happened recently in North Carolina: Only a decade after the state’s Republican politicians described the law as dangerous and refused to sign up for its expansion of Medicaid, Republicans and Democrats came together to pass such an expansion. The Republican-controlled House in North Carolina passed the bill 87 to 24, while the Republican-controlled Senate passed it 44 to 2.“Wow, have things changed,” Jonathan Cohn wrote in a HuffPost piece explaining how the turnabout happened.Obamacare — the country’s largest expansion of health insurance since Medicare and Medicaid in 1965 — is still not as widely accepted as those programs. North Carolina became the 40th state to agree to expand Medicaid under Obamacare, which means that 10 states still have not, including two of the largest, Texas and Florida. In those states, more than 3.5 million adults lack health insurance as a result.But the list of states signing up for the program seems to be moving in only one direction: It keeps growing.Source: Kaiser Family Foundation‘Humiliation’In its growing acceptance, Obamacare resembles other major parts of the federal safety net:When Congress was considering Social Security in 1935, conservatives and many business executives bitterly criticized it. One Texas newspaper described Social Security as “a huge sales tax on everybody on behalf of the oldsters.” A Wall Street Journal editorial predicted that the law would eventually be reason for Congress to look back in “humiliation.” Not exactly: Social Security is so popular that it is known as a third rail in American politics.When Congress was debating Medicare in the 1960s, Ronald Reagan — then an actor with a rising political profile — attacked the program as a step toward socialism. If it passed, Reagan warned, “We are going to spend our sunset years telling our children, and our children’s children, what it once was like in America when men were free.” As president, Reagan praised and supported the program.After Congress created Medicaid — a health-insurance program primarily for low-income households — in 1965, some states did not initially join it. Arizona became the last to do so, in 1982.Roberts and McCainIn the initial years after Obamacare’s passage in 2010, it was similarly divisive. Blue states embraced it, while many red states rejected its voluntary Medicaid expansion. In Washington, congressional Republicans and Donald Trump tried to repeal it. Some Republican-appointed judges invalidated parts of it, and every Republican appointee on the Supreme Court except Chief Justice John Roberts voted to scrap the law.Twice, it survived by a single vote — first, by Roberts’s 2012 Supreme Court vote, and then by Senator John McCain’s late-night vote against its repeal in 2017. Since then, however, Obamacare has been gaining Republican support.The next year, voters in Idaho, Nebraska and Utah — red states, all — passed ballot initiatives expanding Medicaid. Oklahoma, Missouri and South Dakota have since done so. Montana’s state legislature has also approved an expansion.American Medical Association Communications DivisionIn 2019, Gov. Andy Beshear of Kentucky, a Democrat, narrowly won election in a Republican state by pledging to protect an earlier Medicaid expansion. In North Carolina, Roy Cooper, also a Democrat, became governor in a 2016 upset partly by campaigning in favor of an expansion — and was able to sign one this week.(Before it takes effect, Cooper and the legislature must agree on a state budget.)These developments are a sign of the law’s growing popularity. And that popularity isn’t especially mysterious: In a country with high levels of economic inequality and large numbers of people without health insurance, Obamacare has increased taxes on the affluent to subsidize health care for poor and middle-class families. At root, it is an effort to reduce inequality.Winning the middleEven with its flaws — including its often complicated process for signing up for insurance — the law has achieved many of its aims. The number of Americans without health insurance has plummeted. In states that have refused the Medicaid expansion, by contrast, rural hospitals are struggling even more than elsewhere because they do not receive the law’s subsidies for care.Greenwood Leflore Hospital — in the Mississippi Delta — is an example. It recently closed its intensive-care unit and maternity ward, as our colleague Sharon LaFraniere has reported. Nationwide, states that did not quickly accept Medicaid expansion have accounted for almost three-quarters of rural hospital closures between 2010 and 2021, according to the American Hospital Association.Similar problems in North Carolina were a reason that Republicans there reconsidered their opposition to Medicaid expansion. “We had these people coming down to Raleigh, farmers, business owners, people from rural areas, they were advocating, telling stories,” one Republican state representative told HuffPost.Many Republicans still oppose Obamacare, and some hard-right members of Congress also favor cuts to Medicaid — as well as to Medicare and Social Security. In a country as polarized as the United States, there isn’t much true political consensus. But Obamacare has won over the political middle more quickly than seemed likely not so long ago.Related: The number of people signing up for insurance through Obamacare has surged over the past two years, partly because of a new subsidies signed by President Biden.THE LATEST NEWSPoliticsMike Pence must testify to the grand jury investigating Trump’s role in the Jan. 6 Capitol attack, a judge ruled.Republicans are trying to create obstacles to voting for college students, who lean Democratic.An election for a swing seat on Wisconsin’s Supreme Court has become an expensive political fight.A.I. is already affecting the 2024 elections, producing fake images of Trump getting arrested and videos that mimic Biden’s voice.Migrant DeathsA mourner in Ciudad Juárez, Mexico.Go Nakamura for The New York TimesAt least 38 people died in a fire at a migrant detention center in Mexico, near El Paso, Texas. The fire started after a protest.U.S. policies have created overcrowding and desperation at the border.BusinessLawmakers grilled federal regulators who were supposed to supervise Silicon Valley Bank before it collapsed.Prosecutors added a foreign bribery charge to the list of crimes already pending against the FTX founder Sam Bankman-Fried.Alibaba Group, China’s e-commerce giant, is splitting into six business groups.Other Big StoriesThe shooter who killed six people at a Nashville school this week had legally purchased seven guns recently, the police said.Myanmar’s military dissolved the political party of the imprisoned opposition leader Aung San Suu Kyi.Russia sent a 13-year-old girl to an orphanage after her father criticized the war in Ukraine.An appeals court reinstated the murder conviction of Adnan Syed, the “Serial” podcast subject who was freed after more than 20 years in prison, and ordered a new hearing.OpinionsThe success of Israel’s protests suggests that its democracy is healthier than many feared, Bret Stephens writes.How can doctors better discuss dying with their patients? Start by trusting them, Dr. Sunita Puri writes.MORNING READS“La Ronde Enfantine,” painted circa 1862.The Fitzwilliam Museum, CambridgeStolen painting: He lost a Courbet when he fled the Nazis. His heirs are getting it back.15-minute city: A professor is getting death threats for his walkable urban design plan.A discovery: He solved a math problem by finding what’s known as an einstein.Midday snooze: Can a nap make up for a bad night of sleep?Advice from Wirecutter: Pick the best VPN.Lives Lived: Born into poverty in the segregated South, Randall Robinson galvanized Americans against South African apartheid and advocated on behalf of Haitian refugees. He died at 81.SPORTS NEWS FROM THE ATHLETICN.C.A.A. women’s tournament: Iowa vs. South Carolina is the Final Four matchup many wanted — and the one the sport deserves.A potential $6 billion deal: Multiple bidders have submitted offers to buy the Washington Commanders, including a group that includes Magic Johnson as an investor. Patriots won’t pursue Jackson: New England is out of the Lamar Jackson stakes, and plans to stick with Mac Jones as its quarterback.ARTS AND IDEAS The pistachio Suprême croissant from Lafayette.Julia Gartland for The New York TimesThe ever-changing croissantApparently there’s no end to the forms a croissant can take.Ten years after the Cronut, pastry chefs are twisting croissant dough into pinwheels and squiggles, tying it in knots and stacking it into cubes. They are turning it into breakfast cereal, tie-dyeing it and, in one case, wrapping it around baguettes.When the baker Scott Cioe wanted to lure crowds to Lafayette, a Manhattan restaurant, he turned to croissant dough, coiling it into a photogenic swirl he called the Suprême. “We eat with our eyes as well as our hands,” Cioe told The Times.PLAY, WATCH, EATWhat to CookJulia Gartland for The New York TimesTry cooking pasta like risotto, adding liquid gradually so that the noodles absorb it completely. The result is a creamy, rich dish.What to WatchRob Lowe and John Owen Lowe star in “Unstable,” a new Netflix series that exaggerates their barbed father-son dynamic.What to Listen toLana Del Rey’s ninth album asks big, earnest questions and isn’t afraid to get messy.Late NightStephen Colbert called the Nashville shooting horrible and familiar.Now Time to PlayThe pangrams from yesterday’s Spelling Bee were calculator and coloratura. Here is today’s puzzle.Here’s today’s Mini Crossword, and a clue: Really awesome (four letters).And here’s today’s Wordle. Thanks for spending part of your morning with The Times. See you tomorrow. — DavidP.S. Nicholas Nehamas is joining The Times from The Miami Herald, to cover Ron DeSantis.Here’s today’s front page. “The Daily” is about Israel.Matthew Cullen, Lauren Hard, Lauren Jackson, Claire Moses, Ian Prasad Philbrick, Tom Wright-Piersanti and Ashley Wu contributed to The Morning. You can reach the team at themorning@nytimes.com.Sign up here to get this newsletter in your inbox. More

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      in Elections

      Biden Looks to Bolster Support Among Seniors With a Focus on Health Care

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      In a trip to Las Vegas, President Biden warned that Republicans would endanger popular programs like Social Security and Medicare.LAS VEGAS — One of President Biden’s promises to America’s seniors when he first campaigned for the Oval Office was this: You will pay less for health care.So on Wednesday, with a possible re-election announcement getting closer every day, the president traveled to Las Vegas to boast that millions of older adults would save on their medications thanks to the health care legislation he championed last year.Because of the Inflation Reduction Act, he said, seniors will no longer have to make co-payments for some recommended vaccines like shingles and tetanus, saving them an average of $70 each year in the future.“For seniors on fixed income who often need expensive medications to stay healthy, that constant question is can they take the medications and can they pay the bills without giving up important elements of their life,” Mr. Biden told an audience at the University of Nevada, Las Vegas.“It’s not just your health,” he said. “It’s about your dignity. It’s about your security.”In the 2020 election, Mr. Biden came up short among people 65 and older to former President Donald J. Trump, 48 percent to 52 percent. The president and his advisers are hoping to increase his support among that group in 2024 by arguing that its financial and medical security will be better protected with Mr. Biden in office.The centerpiece of that argument so far has been the fate of the government’s primary retirement programs, Social Security and Medicare. Mr. Biden has been aggressive in seizing on proposals by a handful of Republican politicians to argue that the party would put the popular programs in danger.He said as much on Wednesday, standing in front of a sign at the University of Nevada that said “Lowering Costs for American Families.” The president recounted his State of the Union speech this year, when several Republican lawmakers called him a liar for claiming that they wanted to cut the social safety net programs.“I hope it’s true,” he said, noting that the legislators were being filmed as they denied any interest in doing any damage to Medicare and Social Security. “But I’ll believe it when I see it,” he said.Beyond that issue, however, the administration argues that older Americans will also be grateful for the president’s efforts to keep costs down, especially when it comes to their medications, at a time when prices have been rising sharply.In addition to the $70 average savings on vaccines, White House officials said on Wednesday that seniors across the country would benefit from provisions in the Inflation Reduction Act that penalize drug companies when they increase the cost of a drug faster than inflation..css-1v2n82w{max-width:600px;width:calc(100% – 40px);margin-top:20px;margin-bottom:25px;height:auto;margin-left:auto;margin-right:auto;font-family:nyt-franklin;color:var(–color-content-secondary,#363636);}@media only screen and (max-width:480px){.css-1v2n82w{margin-left:20px;margin-right:20px;}}@media only screen and (min-width:1024px){.css-1v2n82w{width:600px;}}.css-161d8zr{width:40px;margin-bottom:18px;text-align:left;margin-left:0;color:var(–color-content-primary,#121212);border:1px solid var(–color-content-primary,#121212);}@media only screen and (max-width:480px){.css-161d8zr{width:30px;margin-bottom:15px;}}.css-tjtq43{line-height:25px;}@media only screen and (max-width:480px){.css-tjtq43{line-height:24px;}}.css-x1k33h{font-family:nyt-cheltenham;font-size:19px;font-weight:700;line-height:25px;}.css-1hvpcve{font-size:17px;font-weight:300;line-height:25px;}.css-1hvpcve em{font-style:italic;}.css-1hvpcve strong{font-weight:bold;}.css-1hvpcve a{font-weight:500;color:var(–color-content-secondary,#363636);}.css-1c013uz{margin-top:18px;margin-bottom:22px;}@media only screen and (max-width:480px){.css-1c013uz{font-size:14px;margin-top:15px;margin-bottom:20px;}}.css-1c013uz a{color:var(–color-signal-editorial,#326891);-webkit-text-decoration:underline;text-decoration:underline;font-weight:500;font-size:16px;}@media only screen and (max-width:480px){.css-1c013uz a{font-size:13px;}}.css-1c013uz a:hover{-webkit-text-decoration:none;text-decoration:none;}How Times reporters cover politics. We rely on our journalists to be independent observers. So while Times staff members may vote, they are not allowed to endorse or campaign for candidates or political causes. This includes participating in marches or rallies in support of a movement or giving money to, or raising money for, any political candidate or election cause.Learn more about our process.Officials said that 27 specialized drugs recently met that criteria, and that their makers would be required to pay rebates to the federal government for the extra costs. Administration officials said that older Americans might see some savings in the future as drug companies keep prices lower to avoid having to pay the rebates.“Some people with traditional Medicare or managed care Medicare may stand to save starting in just a matter of weeks,” Health and Human Services Secretary Xavier Becerra told reporters before the president’s appearance.Mr. Biden also highlighted the impact that his health care actions have had on the cost of insulin, which is a common — and usually expensive — drug for many seniors who suffer from diabetes.The president’s health care law caps the price of insulin at $35 per month for older adults, and Mr. Biden has succeeded in persuading two of the three biggest drug manufacturers to lower costs for younger people in need of insulin. Eli Lilly announced this month that it would cap out-of-pocket costs for insulin at the same $35. Novo Nordisk said it would cut the cost of its insulin drug by 75 percent.The focus on medical costs for older adults has been part of Mr. Biden’s agenda since before he became president. His campaign website said under the heading “The Biden Plan for Older Americans” that seniors in the United States “deserve to retire with dignity — able to pay for their prescriptions and with access to quality, affordable long-term care.”But his policy ambitions are now part of a political effort to win back some in that demographic who have trended toward Republicans as the average age of people living in the country increases each year.A group of about two-dozen Republican lawmakers is pushing legislation to repeal the Inflation Reduction Act, a move that White House officials and the president have seized on. Mr. Biden wants to make his Republican White House rival — whomever that turns out to be — pay for a repeal effort by suggesting that it will hurt older adults.In a statement last month, the White House said that efforts to repeal the law “would give tens of billions of dollars in subsidies back to Big Pharma, raise seniors’ prescription drug prices and raise taxes on an estimated 14.5 million people — all while increasing the deficit.”Mr. Biden’s visit to Las Vegas comes just weeks before he is expected to announce that he is running for a second term. Nevada is a critical swing state that Democrats need in their column if they want to retain control of the White House for another four years. In 2020, Mr. Biden won the state with 50.06 percent of the vote, to Mr. Trump’s 47.67 percent.Wednesday’s speech took place at the William F. Harrah College of Hospitality, a nod to the service unions that are extremely powerful in Las Vegas and an important Democratic constituency. More