THE NEW YORK TIMES NATIONALTUESDAY, OCTOBER 8, 2019 N AERIE, Pa. — Mark Graham, a
real estate appraiser in this faded
manufacturing hub, sat with
friends at a gym named FitnessU
on the morning after the Demo-
cratic debate in mid-September.
He had voted for Barack Obama,
but in 2016 he took a gamble on
Donald Trump. Although he called
the president’s conduct in office “a
joke,” he was unwilling to commit
to voting Democratic in 2020, un-
convinced by the 10 party hope-
fuls the night before.
Jump ahead to October and
Democrats in Congress are inves-
tigating evidence of President
Trump’s possible abuse of power.
Mr. Graham has had an electoral
conversion.
“Things have changed in the
last couple weeks: More stupidity
has come out,” Mr. Graham, 69,
said in a telephone interview last
week. He hopes Democrats nomi-
nate former Vice President Jo-
seph R. Biden Jr., but he is not par-
ticular. “I’d vote for the Democrat-
ic nominee no matter who it is at
this point,” he said. “If Mr. Trump
gets into another four years,
where he’s a lame duck, it’s going
to be like adding gasoline to the
fire.”
Heading into 2020, there is in-
tense focus among campaign
strategists on the weakest ele-
ment of the Trump coalition: the
millions of voters who disap-
proved of both major candidates
in 2016 but took a chance on Mr.
Trump. Whether an impeachment
inquiry moves Obama-Trump vot-
ers like Mr. Graham off the fence,
one way or the other, is a major
narrative arc in the 2020 script
that is rapidly unfolding and up-
dating.
Erie County in western Penn-
sylvania holds a wealth of these
conflicted voters. That much was
clear in interviews conducted in
the days after the 2016 election,
and it’s clear now. Mr. Trump won
an upset national victory by car-
rying places just like Erie County,
long a blue-collar Democratic
stronghold; he won here thanks to
a 17-point swing from Mr. Obama’s
margin of victory in 2012. The ar-
ea’s flip from blue to red was a mi-
crocosm of how Mr. Trump pulled
off narrow victories in this state as
well as in Michigan and Wiscon-
sin.
In interviews in Erie last
month, before the impeachment
inquiry began, many of the Trump
voters from 2016 were either sup-
portive of the president or unper-
suaded by the Democratic alter-
natives. But reached by phone af-
ter the inquiry was announced,
some of these voters had changed
their minds. Outright conversions
like Mr. Graham’s, while still rare,
were reflected in an uptick of sup-
port for impeachment by inde-
pendent voters in recent national
polls.
“I don’t know which way the im-
peachment issue is going to cause
public opinion to move,” said Jo-
seph Morris, a political scientist at
Mercyhurst University in Erie,
who was polling local voters when
news of the impeachment inquiry
broke.
“Undoubtedly a majority of vot-
ers that voted for Trump will vote
for him again in 2020,” Mr. Morris
said. “But I think the jury is still
out when it comes to those inde-
pendents or any Democrats who
chose to vote for Trump in 2016.”
Two strong predictors of a pres-
ident’s re-election odds — support
for his handling of the economy
and voters’ overall approval — are
pulling in opposite directions in
Mr. Morris’s latest survey of Erie
County, which suggests a close
election in this battleground
county in a battleground state. Ap-
proval of Mr. Trump overall is dis-
mal at 38 percent, but 52 percent
approve of the way he’s handling
the economy.
Obama-Trump voters like Mr.
Graham totaled some 6.7 million
people in 2016, according to the re-
sults of the Cooperative Congres-
sional Election Study, a large sur-
vey conducted before and after
elections. Of the nearly one in five
voters who disapproved of both
major 2016 candidates, Mr. Trump
won by a 17-point margin. Another
large study of nearly 7,000 voters
in January 2019 found that
Obama-Trump voters were the
only slice of the electorate whose
approval of Mr. Trump has signifi-
cantly eroded. “Even small move-
ment among these voters — whorepresented 5 percent of voters in
2016 — may prove significant
heading into the 2020 presidential
election,” wrote one of the election
scholars behind the study.
Mark Miller, the third-genera-
tion owner of Miller Brothers’
lawn and garden supply store in
Erie, is a longtime Republican
who cast a grudging vote for Mr.
Trump.
We met last month for breakfast
at Dominick’s, the same 24-hour
restaurant downtown where I in-
terviewed him in 2016. Mr. Miller
said at the time the likelihood he
would vote Democratic in 2020
was “50-50.” And he was still “50-
50” when we spoke this month.
Among the Democratic candi-
dates he could potentially sup-
port, Senator Cory Booker of New
Jersey impressed him as a happy
warrior on the campaign trail. He
liked Mr. Biden because he was
not promising the moon.
“I gave the other guy a shot,”Mr. Miller said of the president. “I
don’t like the way he talks to peo-
ple. I don’t like what he’s doing in-
ternally with the cabinet. I don’t
think anybody feels comfortable
that we have anything cohesive at
the top right now.”
A small-business owner with
about 20 employees, Mr. Miller, 55,
calls himself “a really conserva-
tive family guy,” who sent four
children to Catholic schools.
He was not ready in September
to say he would vote Democratic,
and the impeachment inquiry has
not changed his mind.
“Talking to people coming
through the doors daily, there’s in-
formation overload and they’re
not sure what to believe,” he said
last week, speaking from his store
after closing hours.
He said it was wrong for the
president to ask a foreign country,
Ukraine, to investigate a political
rival, Mr. Biden. But he added, “I
don’t know if that’s egregiousenough to warrant full impeach-
ment.” He continued, “I’d like to
see everybody get back to work on
the business of the country.”
Lyne Daniels, a 52-year-old
Obama-Trump voter in Erie, said
congressional Democrats should
be working with the president on
issues like health care and immi-
gration. “All they’re doing is, Get
Trump, Get Trump, Get Trump,”
she said of the impeachment in-
quiry.
Ms. Daniels, who works both as
a municipal secretary and for a
clothing store, knows exactly who
she’ll vote for in 2020: Mr. Trump.
She said the president had ful-
filled his promises to put “America
First” by avoiding foreign wars
and ending decades of what she
called open borders.
Ms. Daniels said she voted for
Mr. Obama twice because he faced
Republicans she disliked and re-
garded as members of the estab-
lishment. She called Senator JohnMcCain, the 2008 nominee, “a
traitor to this country,” adding,
“I’ve done my own research.”
Even fans of Mr. Trump often
say they wish he would lay off
Twitter. Not Ms. Daniels, who
called it a “brilliant” diversionary
tactic. “He plays you, the press,
like a fiddle, and you fall for it ev-
ery time,” she said. “He gets ev-
erybody talking and it sucks up
airtime for days. Meanwhile over
in the corner, we’re working on
this thing nobody knows about.”
Asked about Mr. Trump’s thou-
sands of documented falsehoods
in office, Ms. Daniels pushed back.
“Based on whose sources?” she
demanded. “Just because the
news tells me that his claims are
false is a little hypocritical be-
cause we had to listen about Rus-
sia, Russia, Russia for two years,
and they were wrong. Who are
they to say what’s coming out of
his mouth is wrong?”
In the 2018 midterms, Demo-
crats did well in the three Pennsyl-
vania counties that Mr. Trump had
flipped: Erie, Luzerne and
Northampton. Gov. Tom Wolf, a
Democrat, carried all three. Ron
DiNicola, a Democrat running for
Congress, won Erie County by 20
points, though he lost the race be-
cause rural counties in the district
voted Republican.
“I feel like our country has been
more divided than ever,” said
Stephanie Johnson, 38, a substi-
tute teacher and registered Liber-
tarian in Erie County. “I see it just
being a mom, being out and about,
at the grocery store, after school. I
feel like people are so angry nowa-
days.”
Ms. Johnson worries that a de-
cline in attendance at her family’s
church is related to the divisive-
ness of America under Mr. Trump,
whom she has no interest in vot-
ing for in 2020. “I feel like there are
a lot of people who aren’t putting
their full trust and faith in God,
and are sort of scared and angry
about what’s going on in the
world,” she said. A president with
no self-restraint on how he speaks
about others has spread coarse-
ness, Ms. Johnson said. “Like, it’s
just gotten to the point where no-
body has any compassion for each
other.”
Still, Ryan Bizzarro, a Demo-
cratic state representative from
Erie County, said, “If this economy
holds on,” Mr. Trump “is going to
be tough to beat.”
Republicans “have been able to
hijack our narrative because
we’re so focused on a lot of the so-
cial issues — which are important,
but people are voting again with
their wallets,” Mr. Bizzarro said
last month.
Once a city reliant on heavy in-
dustry, Erie is moving past the
stereotype of Rust Belt decrep-
itude. Its largest employer was
once a General Electric plant
making locomotives but is now
Erie Insurance. Lost manufactur-
ing jobs are being replaced by
start-ups making computer and
electronic parts.
Mr. Bizzarro, 33, was skeptical
that Mr. Biden would end up as the
nominee. If Democrats nominate
one of his two closest current ri-
vals, Senator Elizabeth Warren of
Massachusetts or Senator Bernie
Sanders of Vermont, Mr. Bizzarro
sounded leery of their ability to
carry Erie County without a surge
of voters from his own generation.
Millennials, whose turnout con-
tinues to lag older voters, “damn
well better show up for the elec-
tion,” he said.A Quandary for Voters Who Flipped: Stay Resolute, or Backtrack?
In the 2016 election, Erie County, Pa. had a 17-point swing in President Trump’s favor from Barack Obama’s 2012 margin of victory.PHOTOGRAPHS BY ALLISON FARRAND FOR THE NEW YORK TIMES‘If Mr. Trump gets into another four
years, where he’s a lame duck, it’s going to
be like adding gasoline to the fire.’
MARK GRAHAM, 69, a real estate appraiser who said he
would vote for the Democratic nominee.‘I don’t think anybody feels comfortable
that we have anything cohesive at the
top right now.’
MARK MILLER, 55, a business owner who said he could
potentially support Senator Cory Booker of New Jersey.By TRIP GABRIELWASHINGTON — As Senator
Bernie Sanders recuperates from
the heart attack he suffered
while campaigning last Tuesday
in Las Vegas, he will inevitably
face questions in the coming
days as to whether he will con-
tinue his presidential campaign
and, if so, at what pace.
Let’s start with some facts
straightaway. A heart attack does
not disqualify anyone from run-
ning for and holding public office.
Modern medicine enabled Presi-
dents Dwight D. Eisenhower and
Lyndon B. Johnson and Vice
President Dick Cheney to contin-
ue in their roles after having
suffered heart attacks, as others
serving in Congress or state
governments have done. (It is
important to note that the popu-
lar but nonspecific term “heart
attack” describes an array of
heart problems; one is myocardi-
al infarction, or the death of
heart muscle cells, which is what
Mr. Sanders had.)
By every indication, Mr. Sand-
ers plans to continue his cam-
paign for the presidency, and
even told staff members on a
telephone call Monday that he
feels more “more strongly about
the need for a political revolution
today than I did when I began
this campaign.”
Former Vice President Joseph
R. Biden Jr., one of the race’s
leading candidates, also once
faced questions about his ability
to serve in public office because
of a serious medical problem. In
1988, as a 45-year-old senator
from Delaware, he experienced a
near fatal rupture of an aneu-
rysm in an artery in his brain.
Shortly after his emergency
surgery for the aneurysm, he
had a second one removed before
it could burst. Because new
cerebral aneurysms can develop
years later in a tiny percentage
of individuals, some experts
suggested that Mr. Biden be
examined for any new aneu-
rysms when Barack Obama
selected him as his running
mate. At the time, Mr. Biden’s
doctor said that he did not need
further testing because he had
recovered fully and done well for
20 years.
Mr. Sanders is certainly not
the first candidate whose presi-
dential campaign was disrupted
by a medical emergency. In 1999,
former Senator Bill Bradley
made an unexpected visit to a
hospital in the San Francisco Bay
Area for atrial fibrillation, a heart
rhythm abnormality, which he
did not disclose until after the
incident. After canceling a few
events, Mr. Bradley, now 76,
resumed his campaign, but he
eventually dropped out of the
race after losing the New Hamp-
shire primary. A poll of New
Hampshire voters revealed con-
cern about how he had handled
the disclosure of his health issue.
Still, Mr. Sanders’s case is
unusual in many respects: He is
a leading candidate recovering
from a heart attack at age 78 whomust compete in an intensely
competitive primary while also
holding down a demanding job as
senator. Indeed, Mr. Sanders’s
disruption comes amid increased
pressure to bolster voter support
with strong challenges from Mr.
Biden and Senator Elizabeth
Warren, and it is unclear at what
pace Mr. Sanders will carry on
his campaign.
“Bernie will be scrutinized
very carefully in the next month
or two for his ability to come
back and campaign as vigorously
as he has done in the 2016 and
current presidential campaigns,”
said Ed Rollins, a former adviser
to President Ronald Reagan.
“He’ll be looked at a little differ-
ently” for things like being tiredat the end of the day or stum-
bling in his delivery onstage, Mr.
Rollins added.
“I have never known a poli-
tician or big moneyed guy or
anyone who has had a first heart
attack” not consider his mortal-
ity, Mr. Rollins added. Also, Mr.
Sanders “surely will think about
a running mate.”
Based on the health informa-
tion he and his doctor provided
when he ran in 2016, it would not
have been possible to predict the
Vermont senator’s heart attack
last week. At that time, his doc-
tor said that Mr. Sanders was “in
overall very good health” and
that his ailments included gout, a
mild elevation of cholesterol,
diverticulitis and an underactivethyroid gland for which he took
daily hormone therapy. Tests
showed that Mr. Sanders’s thy-
roid function and electrocardio-
gram tests were normal and that
he had no reported history of
heart disease. It is not known
whether Mr. Sanders has had a
full medical checkup since then.
Over the long term, however,
“older patients are at higher risk
of recurrent cardiac events after
a heart attack,” said Dr. Christo-
pher P. Cannon, a cardiologist at
Brigham and Women’s Hospital
in Boston. “But Mr. Sanders
appears to have few cardiac risk
factors like high blood pressure
and diabetes.” He pointed to data
from a series of his team’s pub-
lished studies that showed a
one-in-five chance within five
years after a first heart attack
that a second one, or even stroke
or death, might occur.
But such population-based
statistics provide general odds
and cannot necessarily be ap-
plied to an individual.
“Very few illnesses would
preclude someone from holding
high office,” said Dr. Jonathan S.
Reiner, a cardiologist at George
Washington University Hospital
in Washington, who treated Mr.
Cheney for serious heart disease
for many years before, during
and after his two terms in office.
“But the public has a right to
know the salient details because
the ailment or treatment can
affect how the candidate per-
forms in office.”Although there are legal pro-
tections to keep health informa-
tion confidential, most candi-
dates seeking the presidency in
recent years have responded to
the public demand to know and
have waived that privilege.
“The public should have suffi-
cient facts to understand the
magnitude of the event and the
near- and long-term prognosis
for the candidate,” Dr. Reiner
said. “Mr. Sanders’s campaign
has released too few details to
understand the medical impact
of the heart attack on his health.”
Not all heart attacks, for exam-
ple, are of the same dimension.
Like Mr. Sanders, three other
presidential candidates are also
septuagenarians. Mr. Biden will
be 77 next month and Ms. War-
ren is 70. All three have said they
will release their medical records
before the Iowa caucuses that
begin in February, although Mr.
Sanders’s incident last week may
push his top rivals to disclose
their records sooner.
Then there is President
Trump, who is 73. He has not
said whether he would release
any health information before or
after his third presidential medi-
cal checkup, which is expected in
early 2020. While presidents are
not required to have medical
checkups or release findings if
they have one, Mr. Trump re-
leased a detailed summary after
his first presidential exam and a
less detailed one after his second,
earlier this year.NEWS ANALYSISScrutiny for a Front-Runner in a Close Race After a Heart Attack
By LAWRENCE K. ALTMAN, M.D.Senator Bernie Sanders leaving Burlington International Air-
port. He is back home after being treated for a heart attack.STEVEN SENNE/ASSOCIATED PRESS