Locked in a tight race with John Kerry (search) in Ohio, President Bush (search) on Tuesday promoted his administration's record on health care for the low-income and uninsured in a Democratic stronghold.

Making the 17th trip of his presidency to the state, Bush told a crowd of health care professionals that it is important to achieve his five-year goal of opening or expanding 1,200 health centers to serve more than 6 million people. The Youngstown Community Health Clinic (search) treats mostly uninsured patients in this blue-collar city hit hard by job losses.

"This is part of the safety net, a wise expenditure of taxpayers' money," the president said. "We're trying to get up to serving 16 million people." The president said the health centers are cost-efficient alternatives to unnecessary visits to hospital emergency rooms.

Youngstown joined the northeast Ohio cities of Akron and Cleveland in overwhelmingly voting against Bush in 2000, when the Republican won the state over Al Gore by about 4 percentage points.

The Kerry campaign said Bush has done a dismal job of improving health care, especially for low-income people and the uninsured. Families are paying 49 percent more for their health care premiums and 3.7 million more people have lost their health insurance since Bush became president, the Kerry campaign said.

"George Bush's solution to the health care crisis in America is to close his eyes and pretend it's not there," said Kerry campaign spokesman Phil Singer.

Bush, meanwhile, unveiled a new television ad accusing Kerry of "playing politics with national security." The 30-second ad claims that Kerry "voted for the Patriot Act (search)" but "changed his position" after being "pressured by fellow liberals."

The ad says: "While wire taps, subpoena powers and surveillances are routinely used against drug dealers and organized crime, Kerry would now repeal the Patriot Act's use of these tools against terrorists."

Kerry's campaign called the claim fiction, and said that Kerry — along with some Republicans in the Senate — simply wants to change the law to require the government to meet certain requirements before it uses the tools.

This is Bush's second trip this month to Ohio, a reflection of the intensity with which the presidential candidates are pursuing the state's 20 electoral votes. Kerry has visited Youngstown twice this year, most recently April 27 to discuss his plan to create a million new jobs in America.

With Bush's approval ratings at the lowest of his presidency because of the war in Iraq (search), Kerry has edged ahead of the president in Ohio, recent polls show. Kerry was at 49 percent in Ohio, Bush at 42 percent and Ralph Nader (search) at 2 percent in an American Research Group poll taken May 10-12. No Republican has ever won the White House without carrying Ohio.

Kerry has hammered Bush on health care for military veterans in Ohio in recent days because the Veterans Affairs Department is planning to close a hospital in the state under a major restructuring that will close three hospitals, build two new ones, upgrade some facilities and build 156 community-based outpatient clinics across the country by 2012.

Kerry has called it "outrageous" that the Bush administration would try to close any VA hospital.

Regarding Bush's latest visit, "There are probably a lot of so-called Reagan Democrats (search) in the Youngstown area" that Bush "wants to make the play for," said Joe White, chairman of the Case Western Reserve University's political science department.