hospital in bryan but at the same time we have a lot of friends and family and neighbors who just dont have a lot going for them there is a population out there that needs medicaid thats the dilemmait 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 democraticleaning rust belt states mr 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 governmentnearly a million ohio residents gained coverage under the health care act either through expanded medicaid or via the new marketplaces created by the lawthe governor john kasich who has become one of his partys leading pragmatists was one of several republican governors who carried out the medicaid expansion late this past week he joined some of them in a letter to the congressional leadership requesting that the new health care bill be changed so that the medicaid expansion is not ended entirely the states republican senator rob portman has been among the most outspoken republican lawmakers expressing concern over any attempt to quickly end the expansion but the republican congressman who represents defiance and the surrounding area bob latta is an ally of the house leadership and has supported the replacement billimagecreditmaddie mcgarvey for the new york timesfor all the focus on demands by the party hardliners that the repealandreplace bill be less expansive there is also rising concern among mainline republicans from states with large numbers of lowerincome whites about a backlash the group includes mr portman as well as senators lisa murkowski of alaska tom cotton of arkansas bill cassidy of louisiana and shelley moore capito of west virginiathe folks who hillary clinton called the deplorables are actually those who want better coverage who wed be hurting if we dont change this bill mr cassidy said noting that mr trump promised hed give them better carethe senator a physician who once worked in his states charity hospital network bluntly said that the philosophical debate was over and that his party ought to be pragmatic about how best to create a more costefficient and comprehensive health care systemtheres a widespread recognition that the federal government congress has created the right for every american to have health care he said warning that to throw people off their insurance or make coverage unaffordable would only shift costs back to taxpayers by burdening emergency rooms if you want to be fiscally responsible then coverage is better than no coveragea new pew research center survey indicated that the number of republicans making below 30000 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