Mr. Trump, campaigning on Tuesday in Pennsylvania before Mrs. Clinton took the stage, made clear his intent to keep the pressure high. He fused a policy speech, ostensibly on health care, with his more typical broadsides against Mrs. Clinton, briefly holding forth on his announced subject, the Affordable Care Act, but quickly meandering to other topics.
“Hillary Clinton wants to expand Obamacare and make it even more expensive,” Mr. Trump said to cheers in King of Prussia. “She wants to put the government totally in charge of health care in America. If we don’t repeal and replace Obamacare, we will destroy American health care forever. It’s one of the single most important reasons why we must win on Nov. 8.”
As Mr. Trump hoped to capitalize on the renewed F.B.I. attention to Mrs. Clinton’s email server, Mrs. Clinton decided, for the first time in days, not to allude to the controversy at her first public appearance.
Her calculations seemed clear. Her campaign has often been most successful when highlighting Mr. Trump’s controversial statements and behavior, baiting him with well-placed jabs or simply staying out of his way as he lashes out at broadly sympathetic targets, like a Gold Star family or a federal judge of Mexican heritage.
On Tuesday, Mrs. Clinton played all the hits.
She reminded the crowd of Mr. Trump’s comments about Senator John McCain of Arizona, who he suggested last year was not a war hero because he had been captured.
She recalled Mr. Trump’s history of questioning President Obama’s birthplace.
And her introductory speaker was a familiar figure: Alicia Machado, the former Miss Universe whose weight Mr. Trump once disparaged. Mrs. Clinton’s invocation of Ms. Machado at the first presidential debate ensnared Mr. Trump in a protracted feud with the pageant winner, damaging his already precarious standing with women.
“I was scared of him,” Ms. Machado said, adding, “He thinks he can do whatever he wants and get away with it.”
By again elevating Ms. Machado, and seeking a more direct confrontation with Mr. Trump, Mrs. Clinton aimed to establish the kind of direct contrast that aides believe served her well in all three presidential debates.
Her sweeping rebuke of Mr. Trump marked a departure, though, from the tone she had sought to set at times in recent weeks, when Mrs. Clinton hoped — particularly as her lead in the polls seemed to expand — to end her campaign with a largely affirmative case for her candidacy.
She has spoken often of wanting to give Americans “something to vote for, not just against.”
Mrs. Clinton did not entirely abandon earnestness on Tuesday, urging the crowd to unite behind her “positive, optimistic, hopeful and unifying” message.
“I will give my heart to this mission to making the country all it should be,” she said, asking voters about the example they hoped to set for their children.
But the thrust of her address was clear, buttressed by the campaign’s broader efforts to reach voters in the contest’s last days as polls have shown the race tightening, at least somewhat.
Before Mrs. Clinton’s event, her team released a minute-long television ad focusing on Mr. Trump’s treatment of women, scheduled to be broadcast in several battleground states.
Titled “What He Believes,” the ad touches on the accusations of sexual assault against Mr. Trump, his tape-recorded boasts about forcing himself on women, his penchant for wandering into beauty pageant dressing rooms and his remarks insulting the appearance of women through the years.
Onstage, Mrs. Clinton repeated the charges — noting that he even stood accused of walking in on contestants for “Miss Teen U.S.A.,” drawing out the second word — and turned her attention to Ms. Machado.
“She was Miss Universe!” Mrs. Clinton shouted, later asking the crowd to again “stop for a minute and reflect on the absurdity of Donald Trump finding fault with Miss Universe.”
“The bottom line is,” Mrs. Clinton continued, “he thinks belittling women makes him a bigger man.”
A supporter yelled back: “Lock him up!”
For Mrs. Clinton’s campaign, it seemed a welcome change after a weekend spent on the defensive, parrying questions about an F.B.I. review of the emails of a top aide, Huma Abedin.
The heightened attacks on Mr. Trump began Monday, when Mrs. Clinton said her opponent could not be trusted with a nuclear arsenal. Her aides also introduced a television ad modeled on Lyndon B. Johnson’s famous “Daisy” commercial, which was directed at Barry Goldwater in 1964 to emphasize the dangers of placing nuclear weapons in unsteady hands.
Though Clinton advisers are eager to spark a furious response from Mr. Trump, as they succeeded in doing during and after the debates, he largely declined to take the bait, at least initially, in his first appearance on Tuesday.
Instead, he turned his gaze to the president’s health care law, saying its repeal should be a top priority for voters casting ballots over the next week.
He said that if elected, he would call a special session of Congress to repeal the Affordable Care Act and asserted that millennials would be “totally crushed by these massive health care costs before they even get started on their journey through life.”
And at a second event on Tuesday night, in Eau Claire, Wis., Mr. Trump offered a “public service announcement” for any Democrats with “a bad case of buyer’s remorse” after voting early for Mrs. Clinton.
There is still time to change their minds, he said, and in this case, he was right: A handful of early-voting states, including Wisconsin, allow voters to adjust their ballots after the fact.
“You can change your vote,” he said hopefully, “to Donald Trump.”
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