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Medicaid Is Not a Top Campaign Issue. But for These Voters, It’s Crucial.

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Medicaid Is Not a Top Campaign Issue. But for These Voters, It’s Crucial.

It has barely been mentioned on the presidential campaign trail, but few government programs are more entwined in the lives of Americans than Medicaid. The program, whose costs are shared by the federal government and states, provides largely free health insurance to 73 million people — roughly 1 in 5 Americans — many of whom are pregnant, disabled, elderly or chronically ill. Most have limited income.

Enrollment has soared in the decade since states were given the option of expanding Medicaid under the Affordable Care Act to cover adults without young children. It is the among the largest programs in the federal budget, costing more than $600 billion a year.

Presidential elections inevitably bring questions about the future of such a sweeping program, especially if the candidates are pitching costly policies of their own. Former President Donald J. Trump has promised to protect Medicare and Social Security, while also expressing support for a wide variety of tax cuts. Some health policy experts believe that Medicaid would be in the cross hairs as a result.

In his first term, Mr. Trump sought to repeal the Affordable Care Act, including its Medicaid expansion. He encouraged states to require some enrollees to work. And he proposed overhauling how Medicaid is paid for, in a way that would have substantially squeezed it.

Project 2025 — a compilation of proposals written by the conservative Heritage Foundation as a policy agenda for the next Republican administration — calls for work requirements, spending caps, and time limits or lifetime caps on Medicaid benefits. Mr. Trump has repeatedly distanced himself from the plan, but many of its authors, including the one who wrote its health care proposals, served in his first administration.

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Danielle Alvarez, a senior adviser for the Trump campaign, said in a statement that only Mr. Trump and his campaign — “not any other organization” — can speak to plans for a second term. Asked whether Mr. Trump would pursue changes to Medicaid, the campaign provided a list of broad goals related to health care, such as, “Restore the health care safety net by eliminating waste and fraud and refocusing taxpayer dollars on those most in need.”

Vice President Kamala Harris would likely maintain the status quo with Medicaid. In particular, Ms. Harris has promoted a new option that states can adopt, allowing all women who have Medicaid during their pregnancies to keep it for a year after they give birth.

Asked about her plans for Medicaid, a campaign spokeswoman pointed to comments Ms. Harris made at a recent event in Las Vegas: “I firmly and deeply believe that access to health care is a right and should be a right, and not just a privilege of those who can afford it.”

Polls have consistently found Medicaid to have strong bipartisan support from voters, many of whom have personal experience with the program either for their own care or that of a family member. Still, many people may not know the full scope of its reach.

Here are the stories of five Americans and the role Medicaid plays in their lives.

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Video: Community L.A. Fire Brigade Steps In to Help Evacuate Residents

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Video: Community L.A. Fire Brigade Steps In to Help Evacuate Residents

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Community L.A. Fire Brigade Steps In to Help Evacuate Residents

Deep into the evacuation zone, volunteers are stepping in to evacuate L.A. residents from encroaching wildfires. Armed with radios, hoses and knowledge of the area, this brigade offers help to overextended fire departments as they try to reach people who have yet to flee.

“Top is Yankee.” “Victor’s your side. Yankee is the other side of Topanga, OK?” Community fire brigade volunteers are on the streets of Topanga, California. The Palisades fire was encroaching on this home, and Keegan Gibbs and his team were working to evacuate the owner. “OK, hi. So I gotta do this fast, so.” “I honestly just kind of want you to leave, because it’s getting bad.” “No we’re out of here in five minutes.” The brigade works to back up the fire department when resources are stretched thin. “L.A. County and the other supporting agencies are the best in the world at what they do. Events like this, it’s not enough.” The Palisades fire has now been burning for several days, and has destroyed tens of thousands of acres. “It makes no sense for somebody to try to stay here. It’s so unbelievably dangerous.” “I walked kind of with Keegan a little bit. We were going to stay, probably going to stay for a little while, but we walked the property and it’s just almost like, I just don’t think it’s safe. Can you just open that? I’m want to throw some more stuff in here, and then we’ll be good. Just going to put pictures, important memorabilia.” “There’s a huge denial that people won’t be affected by fire, and we have to be advocates for people to realize and accept that risk.” With firefighters still unable to contain two of the region’s largest fires, more L.A. residents are expected to join the tens of thousands who have already been forced to evacuate. “Our mission is to make sure people are safe, just full stop.”

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Malaysia expects surge of Chinese investment, economy minister says

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Malaysia expects surge of Chinese investment, economy minister says

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Chinese chipmakers and technology companies are heading to Malaysia in droves, its economy minister Rafizi Ramli said, as Beijing prepares to face more tariffs when Donald Trump returns as US president this month.

The moves by Chinese companies, which are expected to result in billions of dollars of investment in Malaysia in the coming years, would rival the US companies that have dominated the country’s market, he said.

“Chinese [companies] are very keen to go outside and expand beyond their domestic market,” Rafizi told the Financial Times in an interview. “Those companies are now looking at relocating or expanding into Malaysia.”

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Trump has threatened to impose 60 per cent tariffs on Chinese imports when he re-enters the White House on January 20, rattling investors and putting companies on alert to restructure their supply chains.

Malaysia has been a big beneficiary over the past decade of such “China-plus-one” strategies, where multinational companies complement their Chinese operations with investments in regional countries to diversify risk and lower costs.

It has also positioned itself as a crucial player in global supply chains for high-tech industries such as artificial intelligence, with long-standing semiconductor manufacturing operations in Penang in the north and a burgeoning hub for data centres in the southern state of Johor.

US companies have dominated these sectors in Malaysia, but Rafizi said he expected a wave of Chinese investment on the back of initiatives his government was putting in place to develop the industries further.

Joe Biden’s administration has restricted sales of advanced chips by US companies to China, posing a potential threat to their investments in Malaysia, where many of the products are manufactured, and opening the door for Chinese competitors.

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Rafizi said he made a 10-day trip in June to China, where he met 100 AI, tech and biomedical companies to assess their appetite for investing in Malaysia. He added that these efforts had resulted in two investment delegations from China in the past few months.

“Chinese investments usually come with their own ecosystem,” he said. “We will be seeing more and more, especially if we can secure the first two or three anchor investors from China.”

He added that many companies were also seeking to increase exposure to the fast-growing south-east Asian market as China’s economic momentum slows and trade with the US faces additional barriers.

This week, Malaysia signed an agreement with Singapore to create a vast special economic zone between the two countries. Malaysia hopes the initiative will add $26bn a year to its economy by 2030, bringing in 20,000 skilled jobs and 50 new projects.

Between 2019 and 2023, Malaysia attracted $21bn of investment into its semiconductor industry and $10bn into data centres — the storage facilities that enable fast-growing technologies such as AI, cloud computing and cryptocurrency mining. In the past year alone, US tech companies Amazon, Nvidia, Google and Microsoft committed nearly $16bn, mostly for data centres in Johor.

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TikTok owner ByteDance is the largest Chinese group to invest in Johor, with a $2bn commitment last year.

Rafizi said that while historically, Malaysia had been happy to accept any foreign investment, it was becoming more selective as it sought to contribute more value to the products and services it produced.

He added that while increasing US-China tensions would harm global trade, it could prompt Chinese companies to give Malaysia a bigger role in chip design, rather than just manufacturing, which would generate more income as the country climbed the value chain.

“The unintended consequence of some tariff measures targeted at Chinese companies basically helps countries like Malaysia to weed out the more genuine and long-term investments from China compared to the ones that just look to use Malaysia as a manufacturing outpost,” he said.

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USDA report finds Boar's Head listeria outbreak was due to poor sanitation practices

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USDA report finds Boar's Head listeria outbreak was due to poor sanitation practices

Boar’s Head meats are displayed at a Safeway store on July 31, 2024 in San Rafael, Calif. The USDA released a new report on what led to the listeria outbreak.

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A U.S. Department of Agriculture report has found that “inadequate sanitation practices” at a Boar’s Head facility in Virginia contributed to a listeria outbreak that left 10 people dead and dozens hospitalized around the country last year.

The report, released Friday by the U.S. Department of Agriculture’s Food Safety and Inspection Service (FSIS), reviewed the listeria outbreak linked to the deli meat supplier’s facility in Jarratt, Va.

In one case, inspectors said they found “meat and fat residue from the previous day’s production on the equipment, including packaging equipment.” Other instances included dripping condensation “on exposed product” and “cracks, holes and broken flooring that could hold moisture and contribute to wet conditions.” 

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The outbreak lasted from July through November 2024, according to the Centers for Disease Control and Prevention. With cases reported in over 19 states, it was the largest outbreak of the foodborne bacterial illness since 2011.

In an email to NPR, a spokesperson for Boar’s Head said: “We continue to actively cooperate with the USDA and government regulatory agencies on matters related to last year’s recall, and we thank them for their oversight.”

In addition, the spokesperson said the company is working to implement enhanced food safety programs, “including stronger food safety control procedures and more rigorous testing at our meat and poultry production facilities.”

Boar’s Head recalled its ready-to-eat liverwurst products linked to the outbreak in July. The recall later expanded to dozens of products, including sliced hams and sausages, all of which were manufactured at the Virginia plant.

USDA inspection reports show sanitation violations were routine and not isolated at the plant, NPR previously reported. The reports found dead bugs, dripping ceilings, mildew and black mold near machines at the plant.

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In September, Boar’s Head permanently closed its Jarratt plant and the company announced it would discontinue making any liverwurst products.

Friday’s report also included a review of FSIS’s own practices and procedures to prevent the spread of listeria, including ways to enhance its regulatory and sampling approach to the illness. The report cited “equipping FSIS inspectors with updated training and tools to recognize and respond to systemic food safety issues” as one of the steps the agency would take to protect the public from listeria.

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