between 30000 and about 75000 last year said the government bore responsibility for health care now 34 percent of such voters dothis is a function of donald trump engineering a takeover of the republican party said whit ayres a longtime republican pollster it was takeover more than assimilation and this is the eminently predictable resultimagecreditmaddie mcgarvey for the new york timesbut now that it is mr trumps republican party those who elected him will expect him to fulfill his campaign commitmentsfew republicans can appreciate the political challenges of the affordable care act like davy carter a republican and former speaker of the arkansas house who shepherded the laws medicaid expansion through his conservative legislature in a state where president barack obama was disdainedif he doesnt do what he said he was going to do it will alienate the very voters that put him in office mr carter said referring to mr trumphe has a warning for fellow republicans who represent states with large workingclass populations that like his own have shifted away from their democratic roots they did not change parties because they suddenly became freemarket conservativesmr trump who pledged repeatedly on the campaign trail to undo mr obamas 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 systemwe will take care of our people or im not signing it he said when pressed in a fox news interview last week about how his voters might fareimagecreditmaddie mcgarvey for the new york timesif congress moves ahead with the house version of the bill vulnerable voters might find some allies within the health industry hospitals that serve the rural regions in what could be called trump country would be particularly vulnerable their patients tend to be older poorer and sicker and their profit margins much narrower if they make any profit at allmike abrams president and chief executive of the ohio hospital association worries that repeal of the health law could force some hospitals to close but honestly he said even if they didnt close they would have to make some decisions that would be unwelcome by the communityat defiance regional where mr waltimire the injured police officer gets his care medicaid provides 22 percent of the revenue up from 15 percent before the affordable care act took effect the 25bed hospital part of the promedica health system in toledo has expanded mental health services and is adding a second medical office buildingrandy oostra promedicas president and chief executive said the republican proposal to give states a fixed amount of money for each person on medicaid instead of a large share of whatever each state needs to spend would be particularly wrenchingit will drive down reimbursement over time and were going to start stripping care away mr oostra said they