Midwest tests GOP’s dual imperatives
Party grappling with health plan that could harm Trump voters
DEFIANCE, Ohio — James Waltimire, a police officer on unpaid medical leave, has been going to the hospital in this small city twice a week for physical therapy after leg surgery, all of it paid for by Medicaid.
Waltimire, 54, was able to sign up for the government health insurance program last year because Ohio expanded it to cover more than 700,000 low-income adults under the Affordable Care Act. He voted for President Donald Trump — in part because of Trump’s support for law enforcement — but is now worried about the Republican plan to effectively end the Medicaid expansion through legislation to repeal the health care law.
“Originally the president said he wasn’t going to do nothing to Medicaid,” Waltimire said the other day after a rehab session. “Now they say he wants to take $880 billion out of Medicaid. That’s going to affect a lot of people who can’t afford to get insurance.”
Bridging the gulf
As Republicans in Washington grapple with how to meet their promise of undoing the greatest expansion of health care coverage since the Great Society, they are struggling with what may be an irreconcilable problem: bridging the gulf between the expectations of blue-collar voters like Waltimire who propelled Trump to the presidency, and long-standing party orthodoxy that it is not the federal government’s role to provide benefits to a wide swath of society.
If they push forward the House-drafted health bill, which could come to a vote as early as this coming week, Republicans may honor their vow to repeal what they derided as Obamacare, but also risk doing disproportionate harm to the older, workingclass white voters who are increasingly vital to their electoral coalition.
“People in this community are very conservative. They struggle with the federal budget deficit, and they like the idea of personal responsibility,” said Phil Ennen, president and chief executive of Community Hospitals and Wellness Centers, which has a hospital in nearby Bryan. “But at the same time, we have a lot of friends and family and neighbors who just don’t have a lot going for them. There is a population out there that needs Medicaid. That’s the dilemma.”
Daunting paradox
It is a daunting paradox for a party that, at least in theory, was once unified around a belief that Washington should be tamed, not empowered. But by winning the White House under the banner of economic nationalism, and carrying a series of Democratic-leaning Rust Belt states, Trump has left his adopted party struggling to come to terms with the reality of who are now voting for Republicans — and what they expect from their government.
A new Pew Research Center survey indicated that the number of Republicans making below $30,000 a year who believe the federal government has a responsibility to ensure health coverage for all had risen to 52 percent from 31 percent last year. And while just 14 percent of Republicans who make between $30,000 and about $75,000 last year said the government bore responsibility for health care, now 34 percent do.
Trump, who pledged repeatedly on the campaign trail to undo Obama’s “disastrous” health law, appears torn. He is struggling between the political imperative to fulfill that promise — essential both for symbolic purposes of notching a win and for procedural reasons to go forward with an overhaul of the tax code — and his assurances that “everyone will be covered” under the new system.
“We will take care of our people or I’m not signing it,” he said when pressed in a Fox News interview last week about how his voters might fare.