LEVITTOWN, Pa.—With whiffs of cigarette smoke wafting from the adjoining Band Box bar, surrounded by the nonstop clatter of bowling pins, Donna Brown and Kaci Rickert sat across from each other at a little low table one recent evening at the shabby, homey Levittown Lanes. The women’s league teammates ate salad and ziti and made small talk. Brown got up for her turn, and Rickert offered an admission in what was almost a whisper. “We’re on two different sides of the political aisle,” she said, “but we don’t discuss it.”

There was, however, one perennial problem they wanted to talk about. And when they started, they couldn’t stop.

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“Health care,” said Rickert, 56, a hospice nurse.

“It’s the top issue,” said Brown, 64, a hairdresser.

“Cost … accessibility,” Rickert continued, ticking off her complaints. “There should be some way to limit the high deductibles that are rolling out now. It’s crippling people. It’s crippling me.”

Here in Bucks County, Pennsylvania, anchored by this aging, iconic suburb situated between Philadelphia and Trenton, New Jersey, along the Delaware River not far from where George Washington famously crossed, the margins of electoral victories traditionally are as slim as the spectrum of political opinion is vast. Heading, though, into this year’s midterms, there is one thing that everybody seems to agree on. No matter what they say about President Donald Trump (and they have a lot to say about him), and regardless of what they think of their relatively moderate Republican congressman, Brian Fitzpatrick, the people and particularly the senior citizens and retirees who live in the state’s newly drawn 1st Congressional District are all but in lockstep when it comes to the health care system. It’s broken, they think, and it needs to be more available, affordable and reliable. On this topic at least, toxic partisan strife turns into across-the-aisle ire.

“I’m tired of this,” Brown said.

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“Somebody needs to fix it,” Rickert added.

This area long has been a lens through which to gauge not only the moods and preferences of Pennsylvania but the nation as a whole. Levittown, of course, is practically synonymous with suburbia, built by Bill Levitt in the early 1950s on great swaths of spinach and broccoli. Sold at the outset as “the most perfectly planned community in America,” it actually has served as a tableau of the country’s most intractable troubles, from racism to working-class resentments to today’s debilitating opioid scourge. And the wider county runs the cultural gamut from threadbare strip malls and blue-collar dive bars in Levittown to gourmet olive oil shops and Italian coffee parlors in tonier Doylestown to wineries and nurseries, silver silos and red barns, feed stores and gun stores in its more rural reaches. It is home to yard signs that say “SAVE DEMOCRACY” and “PRAY FOR OUR COUNTRY” and “HATE HAS NO HOME HERE” and at least one Subaru Outback with a bumper sticker calling an assault rifle a “MODERN MUSKET” and challenging anybody who doesn’t like that to “COME AND TAKE IT.”

Spend a few days around these parts and one meets Republicans who used to be Democrats and Democrats who used to be Republicans and voter after voter who insists he or she picks the person over the party. For decades, this district (formerly the 8th, a court-ordered redrawing earlier this year made it a wisp more Democratic) typically has gone for the Democrat for president and a Republican for Congress. And the latest polling shows Fitzpatrick with a narrow lead over Scott Wallace, a philanthropist and self-described “Patriotic Millionaire” running as a guaranteed check on Trump. But it’s always up for grabs. “It’s one of those consummate gettable places for both parties,” said Christopher Borick, a political scientist at Muhlenberg College in nearby Allentown. This year’s stakes are especially high and it’s conceivable that control of the House of Representatives could come down to votes logged here. “It is the district in Pennsylvania that the GOP has to defend at all costs,” said longtime Pennsylvania politico Larry Ceisler. “If this district goes Democratic,” Franklin & Marshall College pollster Terry Madonna said, “the wave is pretty substantial.”

There are, after all, four districts more likely to go blue next month—the 6th, 7th, 8th and 17th are likely or leaning, whereas the 1st is a tossup, according to a POLITICO analysis, making Pennsylvania one of the nation’s most fertile territories for potential pickups for Democrats. Add in the gubernatorial race and a Senate contest—incumbent Democrats are heavily favored in both—and the state stands as an epicenter of these midterms. And older voters are most likely to decide those races; in Pennsylvania more than 1 in 3 registered voters are ages 50 or older.

Given the current volatile landscape, buffeted from the right in his primary and now from the left by Wallace, Fitzpatrick, a 44-year-old Levittown native and former FBI agent bidding for a second term, has spent the past few years trying to distance himself from Trump while supporting his policies the vast majority of the time. He voted for the Trump tax cut, for example, but he also voted against the health care bill that would have gutted President Barack Obama’s Affordable Care Act. And he did that, he explained, because of what he’s heard back home.

It’s hard to miss.

“Health care is still the most important issue of substance on the table,” said Bill Pezza, an adjunct professor of political science and history at Bucks County Community College. That’s true around the country, according to multiple polls, and it’s true here.

“Health care,” Republican retiree Marian Schofield, 85, said without hesitation when she was asked what she’s thinking about the most going into November.

“Health care,” echoed Alice Tardino, 64, co-owner of a video store and a Democrat.

“The biggest fear for a lot of people right now,” added Tina Davis, the area’s state representative and a Democrat, “is will they have health care? Will they be able to get it with pre-existing conditions? That’s the fear that you hear.”

At Levittown Lanes, Brown, who supports Trump, and Rickert, who does not, delved into the specifics of their stories. Brown used to be covered under her husband’s health care, but he retired four years ago from his metalworking job, and she’s had to pay for her own insurance ever since—now $869 a month. She turns 65 later this fall, and she can’t wait—so she can get Medicare benefits. It will shave some $600 off that bill, she said. “I’m paying more for my health care than what we pay for our mortgage.” Rickert, meanwhile, was out of work for six months last year because of a rib she fractured on the job and then pneumonia and other ensuing complications—and she lost her health insurance because of it, she said. She recently started with a new company, still as a nurse, mainly to get more affordable health care. It’s been disillusioning. “There’s no protection for people who get sick who are employed,” Rickert said. “Over time, it doesn’t matter. And medicine is a business. It’s not about people.”

“Everything you do, every job you take,” Brown said, “it revolves around health care.”

“I’m just disgusted with it all,” Rickert said.

Brown blames Congress. Both parties.

“They should have exactly what we have” for care, she suggested. “They’re servants of the people. Isn’t that what they say?” The way she sees it, though, what’s their incentive to work together to come up with solutions? “Until they get the same health care we do …” She brought up the S.S. United States, the derelict ghost ship, rusting just down the Delaware. “Put them all on there,” Brown said, “and sink ’em at sea.”

***

Four miles down busy New Falls Road, inside squat, gray brick Sparky’s World Famous Shot & Beer Bar, dangling strands of Christmas lights cut through the Camel haze of the dark bar on a late afternoon. Jim Hamlen, 75, a retired steelworker and onetime union Democrat wearing a T-shirt that says he’s a Vietnam veteran, took drags and sips of two-buck beer and talked about Trump. “When I first heard Trump, I thought, ‘Oh, no, here we go,’” he said. “But the more I listened to him, the more I thought about it. I always said to myself, ‘This country needs a president who’s a super businessman, who can make deals, and wouldn’t get pushed around.’” What he likes best about what Trump’s doing is the pledge to turn back the clock. “I would like,” Hamlen said, “to go back to the way it used to be.”

In Levittown, same as everywhere else, that means different things to different people. “We bought 5,000 acres, and we planned every foot of it,” said Levitt, a ceaselessly self-promoting, Cadillac-driving cross between Henry Ford and Walt Disney. “Every store, filling station, school, house, apartment, church, color and shrub …” But that, Dianne Harris pointed out in the 2010 book of essays she edited titled Second Suburb, always was unrealistic: “The planned perfection of Levittown becomes a foil against which the imperfections of human subjects play out.” In 1957, angry mobs of white people hurled bottles and rocks through the picture window of the three-bedroom ranch on Deepgreen Lane that housed their first black neighbors. In 1979, an estimated 2,000 residents rioted and 44 police officers got hurt during protests over the lack of gasoline in the wake of the Iranian Revolution. And in the decades since, as factories and industries of the postwar, middle class-ascendant era that facilitated livable wages for workers with limited education dwindled and disappeared, anxieties have intensified.

At the Band Box bar, Mike Episcopo, 52, the co-owner along with his father, fretted over the fact that the cost of health care for his family has doubled of late. “We got clobbered over the last five or six years,” he said. “It was probably $1,100 in 2010, and it’s $2,200 now.”

He’s not sure who or what to blame. But he did mention Obama’s ACA. “I can’t blame it totally on that, but …”

Maybe, he believes, Trump can fix it.

“He’s a little bit crass, but I think I agree with him more than I disagree,” said Episcopo, who has two autistic sons and coaches special-needs hockey. “If the election was today, I’d vote for him again, to see if this’ll come to fruition.”

What “this” on health care might be remains unclear. The consensus of dissatisfaction hasn’t translated into anything remotely approaching possible solutions. The reality is there aren’t even specific proposals to parse. An outright repeal of Obamacare is dead for the time being. The notion of universal health care is little more than a campaign scare tactic. The source of the gridlock is, of course, the extreme partisan divide.

“The biggest problem we face in this country … is hyperpartisanship,” Fitzpatrick said. “It’s very much a polarized, Hatfield versus McCoy, left versus right, red versus blue—and when you think about it, why? … Do people really believe that the Democrat Party or the Republican Party have the answer to all problems? It’s crazy.” Ranked in 2017 by the Lugar Center and Georgetown University as the third-most bipartisan member of the House, Fitzpatrick said he gets “a lot of grief” for even being a part of the Problem Solvers Caucus. He chalks it up to “insecurity and immaturity,” saying it takes “courage” to buck the party line.

The most courageous thing he’s done in Congress? “Voting against the health care bill under immense pressure,” he said. “Immense pressure. From all different corners. … I certainly got pressure from leadership.”

What decided it for him? “It was the people with pre-existing conditions, people with juvenile arthritis, juvenile diabetes, cystic fibrosis, autism—you know, these families that come in, they will just reduce you to tears, hearing their stories of the challenges they deal with, day in and day out, and if you have any heart at all and any soul at all, that is going to be a moving experience for you, and you’re going to understand that we have to accommodate those people, we have to take care of these people. So that fit into the Medicaid issue. … I became a big believer in Medicaid and Medicaid expansion,” he said.

“Everybody should want the same thing: a system that works, that’s innovative, that’s affordable, and that’s universal,” Fitzpatrick continued. “We’ve just got to figure out the best way to get there.”

Whatever that looks like, he insisted, it has to be bipartisan. (Wallace’s campaign decline to comment.)

That seems unlikely. At a local senior center, retired teacher Karren Cherrington, 73, decried Trump and an administration that she sees engaging in an ongoing assault on women. “We spent a long time earning our rights, and I’d like to keep them!” she stressed. “It took us till the ’20s to get the vote and until the ’70s to have control over our own bodies!” Cherrington then apologized for getting so emotional. “Forgive me,” she said.

Across the room, Eddie Fluke, 74, preparing for a fall festival for children by stuffing goodie bags with whistles and pencils and plastic spiders and Dracula teeth, quietly said she voted for Trump and will do it again. “He says something, and he does it, and he doesn’t really care who it annoys,” Fluke explained.

Dori Brenenborg, though, steered clear of taking sides on Trump and instead zeroed in on what for her was top of mind.

“Health care,” she said.

Brenenborg, 73, is a retired insurance agent and now makes extra money with a sewing business on the side. She stood in the senior center’s entryway next to pamphlets about Medicare and hospitals and health fairs and about how to spot a con artist. Her three-month supply of eye drops used to be $200. Now it’s $700 for two months. “What can you cut?” Brenenborg said. “You can’t cut your utilities. You can’t cut your house payments.”

Many of her friends are struggling with the same thing.

“They’ll only take half a pill, or they’ll skip a day—that’s real common,” she said. “I’m fearful of where it’s going. Where does it stop?”

And at the video store, called The Video Store, a 38-year family business that now also sells lottery tickets, takes passport photos and offers faxing and notary services, Tardino shook her head about the president. “I feel he’s dangerous,” she said. “I said that from the beginning. He wasn’t prepared to be president.” But it’s not actually what she’s worried about the most. “My husband is not well,” she said.

John Tardino turned 65 this past summer. He and his wife and their three children always were self-insured. “Very expensive,” she said. When he signed up for Medicare, he picked the most affordable option, having been healthy his whole life. But the blood work from his first physical on Medicare showed moderate kidney failure. He signed up for a different Medicare plan that was pricier but had more comprehensive coverage. He was sent for an ultrasound. He was sent to a urologist. He was sent for X-rays and for more blood work. A doctor ruled out cancer. But his bladder remains inflamed. The Tardinos know their customers by name and commiserate with many of them about what’s going on in their lives, so they needed no reminder to be grateful for good health. “People,” Alice Tardino said, “come in here all the time, in wheelchairs, with health concerns.” But now it’s hitting home. They’re waiting on the results of more tests.

“You never know what’s going to happen,” she said.

“And stuff can happen to you just like that,” he said. “Even at the gym, the guys—we talk about who has to get a hip replacement, a knee replacement. One of my buddies had throat cancer.”

“This is a major, major concern of retirees,” she said.

***

Back at Levittown Lanes, as the evening activities of the women’s league wrapped up, Kaci Rickert turned her attention to her daughter. She’s 25, works as a groomer at PetSmart and last year lost her insurance when Rickert did. Now she’s on her mother’s new plan. But she’ll be on her own once she is older than 26. Rickert spoke of her daughter and her situation with a mother’s fierce pride—but also audible angst.

“She’s doing everything she can to make ends meet. She’s a damn good groomer, a very strong, independent woman,” she said. “But she just can’t afford to do health care, so she’s going to have to end up relying on the emergency room system.”

All over Levittown, Bucks County and Pennsylvania’s 1st District, many retirees, soon-to-be retirees, senior citizens and veterans are uneasy, they say, not even so much about themselves but about their children and their children’s children. Will Medicare still be there? Will costs keep climbing? How will their kids and their grandkids fare in the not too distant future if this president or any president or their representatives in Washington don’t manage to work together to find some way to address the persistent problems with health care?

“I think down the line about what will happen to my children with Medicare, and my grandchildren,” Miriam Schofield said. She’s had cancer, and her husband had a heart attack. As retirees, they’re on a fixed budget. Any increase in health care costs or decrease in availability—especially for people like them with pre-existing conditions—would be a burden almost impossible to handle. “I just worry how much prescriptions have went up, things like that, and hospital care,” Schofield said. And in the years to come? “Who knows down the road what will happen?”

Alice Tardino at The Video Store has two daughters and one son and four grandchildren. She thinks about their health care, and the Environmental Protection Agency, too. “I never really felt old until I saw what this administration is doing,” she said. “I worry about the future’s health because of the EPA regulations being relaxed. … I want the future generations to have the benefits that my children had, and the decisions that are being made now are definitely going to affect my grandchildren.”

Mike Episcopo at the Band Box couldn’t be more different in his support for Trump but shares Tardino’s broad concerns about the future.

“Politically,” he said, “I feel bad for the younger generation.” Student loans? “Off the charts—the next housing crisis, in my opinion,” he added. But health care tops the list.

“Those who are older obviously want to hold on to what they have. And then those who have kids on their health care plan worry about whether they’ll be protected until they’re 26,” said Pezza, the community college professor, who’s always discussing politics and public policy with people here. “They’re worried about whether they’re going to lose that.”

Rickert certainly is.

Her daughter and health insurance on her mind, she started packing up her stuff to head out into the dark night.

“How can she afford it,” Rickert asked, “if I can hardly afford it?”