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GOP misread Trump victory as mandate to gut health care

Protesters opposing the GOP health care bill gathered last week at the Capitol Hill office of Senator Rob Portman, Republican of Ohio.
Protesters opposing the GOP health care bill gathered last week at the Capitol Hill office of Senator Rob Portman, Republican of Ohio.(Manuel Balce Ceneta/Associated Press)

BOARDMAN, Ohio — There’s a deep love for Donald Trump here in the Mahoning Valley, once a reliably Democratic swath of northeastern Ohio that turned purple in the last election. But when it comes to Republicans in general, there’s far less affection from the base, particularly in the wake of a stalled agenda in Washington.

“It’s like they’re still not listening, listening to the people,” said Ruth Nabb, a senior citizen from the area and a Trump supporter who spent Friday morning at the Republican headquarters here. “We’re all tired of it.”

She’s floored that the Republican leadership in Congress didn’t have a workable health care plan ready to swiftly replace the Affordable Care Act. She’s livid that Republican senators, including Ohio’s Rob Portman, stood in the way of passing the Senate version of a health care overhaul. But she also doesn’t like the idea of reducing entitlement programs that benefit her family and community, including less funding for Medicare and dramatic spending cuts to Medicaid that are a core feature of the House and Senate Republican plans.

“They’ve been bitching about this for 7½ years,” Nabb said of the Republicans in Congress. “So they’ve had time to get their ducks in a row.”

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This is the muddle that Republicans leaders in Congress are contending with as they struggle to show results six months after Trump’s inauguration. After rolling into office with winning slogans targeting “Obamacare’’ — a politically problematic moniker that made it easy to mobilize anti-Obama fury against a complex law — they either missed or ignored lessons of Trump’s jaw-dropping, populist-fueled victory. Trump himself understood the pitfalls, when he promised during the campaign that, while repealing Obamacare if he won office, he would not touch Medicare and Medicaid and would not roll back ACA protections for people with preexisting conditions. It was a bundle of contradictions rolled into a pitch, but it proved persuasive to his voters.

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The president plans to visit the area Tuesday and hold a campaign-style rally in nearby Youngstown, where he’ll likely talk about the so-far stymied health care overhaul.

He’ll have to navigate tricky ground, explaining why, with his sometime encouragement, House Speaker Paul Ryan and Senate majority leader Mitch McConnell forged ahead with an ACA replacement that relied heavily on standard GOP doctrine. The bills they introduced cut deeply into health care entitlement programs for the poor and lower-income working class, while granting generous tax reductions to corporations and the wealthy.

It appears to have been a profound misreading of the Trump base, which directed most of its 2016 election anger at economic elites and Washington’s continued inability to boost middle-class fortunes. Tax burdens on millionaires and Medicaid budgets were not high on their list of concerns.

McConnell’s and Ryan’s offices didn’t reply to e-mails requesting comment.

Polls confirm that the vast majority of Americans — including big swaths of the white, middle-class coalition that was key to Trump’s victory — have little appetite for the congressional Republican moves on health care. Moreover, Republican governors and moderate Republican senators said deep Medicaid cuts would devastate thousands of working-class citizens and gut rural hospitals.

Even as the Senate lurches toward yet another planned vote on its unpopular health care bill this week, uncertainties remain on the horizon over the next big item on the Republican agenda: cutting personal income and corporate taxes. The populist base that elected Trump may again erupt if the plan is seen as favoring wealthy interests at the expense of regular Americans.

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Some local Republicans privately say the leaders in Washington have not yet caught up with the Trump phenomenon.

The 2016 election “was so unexpected, people are having trouble understanding what it means,” said one Ohio Republican strategist who requested anonymity to speak freely. “There’s such confusion about what we’re supposed to be.

“What are we supposed to take away from this election? That we’re a new majority Republican Party? We didn’t win the popular vote,” the strategist added.

Polls show that the GOP Senate health care plan has low approval numbers even among the GOP faithful. Only 35 percent of Republicans like it; 32 percent of Tea Party supporters approve of it; and 36 percent of Trump supporters like it, according to a recent NPR/PBS NewsHour/Marist poll. It’s most popular among those who call themselves “strong Republicans” — but even then it clocks a 43 percent approval level.

A Republican health care overhaul passed in the House 217 to 213, with 20 Republicans voting against. No Democrat voted for it. It would leave 23 million more Americans without health insurance in the next decade, according to the nonpartisan Congressional Budget Office. And it would trim $119 billion from the federal deficit.

Trump, burdened by scandals and presiding over a White House with almost no governing experience, has not offered a clear message on how to repeal or replace the Affordable Care Act. He described the House bill as “really incredible” in a Rose Garden ceremony after the measure passed in early May. But weeks later, when hosting a lunch with GOP senators in June, he referred to the measure as “mean” and instructed them to write a bill that was “more generous.”

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Last week, as the Senate remained unable to muster the majority needed to pass a bill, Trump floated several ideas over the course of two days: letting Obamacare collapse under its own weight, repealing Obamcare without offering a replacement, and doubling down on a repeal-and-replace plan.

The Senate version of repeal and replace would leave 22 million uninsured and cut $420 billion from the deficit, according to the CBO. A straight repeal, with no replacement, would mean 32 million more uninsured.

“Health care is so personal,” said Senator Susan Collins, the Maine Republican who is opposing the Senate measure largely because of the damage it would do to Medicaid recipients and rural hospitals in her state.

Over the July Fourth weekend, Collins ran into a staunchly conservative constituent who frequently chides her for being too moderate. As the woman approached, Collins braced herself. “I thought ‘Uh, oh. Here it comes,’ ” she recalled, expecting to hear an earful about her opposition to the Senate GOP plan.

Instead, the woman wanted Collins to meet her grandson who has cystic fibrosis. “She was so worried about the Senate bill,” Collins said. “That’s going to be a preexisting condition for him his entire life.”

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Proposed Senate Medicaid cuts, which would amount to more than $770 billion over 10 years, are unacceptable, she said. Within 20 years, Medicaid spending would be 35 percent less than under current law.

“You can’t take that kind of money out of a health care program and think that it’s not going to have some kind of negative impact,” Collins said to reporters Friday. “You don’t take a safety net program that has been operating for more than 50 years and change it in fundamental ways without having a single hearing.’’

Tracey Winbush, the vice chair of the Mahoning County Republican Party, offered a measure of disgust with Senate majority’s decision to craft an unpassable bill and failing to seek support from Democrats (whom she separately scorns as being obstructionist).

“It’s not the Republicans who really put [Trump] in office,” Winbush said. “There is nothing wrong with having bipartisan input on a bill. We’re not going to burn down the whole country because we don’t have a super majority.”

Winbush, over dinner at the Springfield Grille, a popular steak joint, pulled out her smartphone and pointed to a recent story that the state’s largest Medicaid managed care provider is set to cut ties with the Cleveland Clinic, a speciality hospital that serves many in northeastern Ohio.

“It would be devastating,” she said, if the poor or disabled were unable to access care at Cleveland Clinic. She says she believes Trump would agree.

Winbush knows first hand. She’s been diagnosed with multiple sclerosis and has a health plan through her employer. But she likes the safety net.

“Should I ever lose my benefits or lose my job . . .” she said, trailing off.

Steven Glass, the chief financial officer for the Cleveland Clinic, said the hospital hopes to resolve the issue.

He added that 13 percent of its patients are covered through Medicaid.

Even some of the people who helped Trump win the presidency acknowledge that Obamacare has some appeal — a considerable shift given the heated campaign rhetoric.

“Here in Ohio, they want results. And they want something different,” said Rob Scott, who was Donald Trump’s deputy state director in Ohio during the general election and is a city councilman in Kettering, Ohio.

“I’m not saying that people out there, that the ACA has done all bad,” said Scott. “There have been things in it that have done good,” he added, ticking off guaranteed coverage for preexisting conditions and allowing parents to keep their children on their insurance plans.

As a conservative, he wants it erased. But he’s hearing a new theme: “There is an acknowledgment that there have been some things that the ACA has done that are good,” he said.


Victoria McGrane of the Globe staff contributed to this report. Annie Linskey can be reached at annie.linskey@globe.com. Follow her on Twitter @annielinskey.