Trump gambles on cultural frustration over economic self-interest

Health care promises made by candidate Trump
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(CNN)Chaos may have seemed the only guiding principle in the White House last week. But amid President Donald Trump's Twitter tirades; the vulgar rant from his new communications director; the open internecine sniping; and the White House staff shakeup, the President offered two revealing hints about the policy direction he believes may rebuild his fraying political support.

Taken together, the two signals amount to a gamble from the President that cultural affinity can trump economic self-interest for the older and blue-collar white voters central to the coalition that elected him.
The key economic signal that Trump offered last week was his unreserved embrace of the stalled Senate effort to repeal the Affordable Care Act, despite abundant evidence those older and working-class white voters would be among the biggest losers in all of the Republican replacement plans. That decision underscored Trump's conversion to the long-standing drive by the Congressional GOP -- especially House Republicans allied with Speaker Paul Ryan -- to systematically retrench the social safety net, despite Trump's conspicuous campaign promises to protect Social Security, Medicare and Medicaid.
The key cultural signals Trump provided came in two actions that directly bracketed the failed Senate votes last Thursday to uproot the ACA. One day before the vote, the administration issued a flurry of decisions rolling back transgender and gay rights. Speaking just hours after the vote, Trump braided a blistering attack on undocumented immigrant gang members (who he repeatedly labeled "animals") with a plea for unshackling law enforcement from what he called "pathetic" big city mayors.
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    Those twin initiatives marked an escalation of cultural conservatism aimed directly at many of those same older and blue-collar whites' fears that they are being eclipsed by the hurtling demographic and social changes remaking American society.
    Sandwiched between these sharp messages was last week's spectacular legislative crackup in which Senate Republicans failed to approve any of three major options for uprooting the ACA. Many tactical missteps contributed to the debacle.
    But the effort also splintered against a more fundamental obstacle: the GOP's alternatives all imposed many of their greatest costs on groups and communities that the party now depends on to win elections. In that way, the sputtering drive to repeal the health care law encapsulated the larger Republican struggle to adapt their historic small-government ideology to the material interests of their modern political coalition, which revolves around older and blue-collar whites who often rely on government safety net programs.
    As a candidate, Trump clearly acknowledged that shift in the GOP coalition when he promised to block cuts to Social Security, Medicare and Medicaid, three programs essential to working-class Americans of all races.
    Yet as President, Trump quickly deferred to congressional health care plans that hit hard at both blue-collar whites (who provided him the largest margin enjoyed by any presidential candidate in either party since Ronald Reagan in 1984) and older working adults (at a time when about two-thirds of all Americans 45-64 are white and most of them vote Republican.)
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    Whites without a college degree represented a majority of those who gained coverage under the ACA in each of the Rustbelt states that tipped the 2016 election (Iowa, Ohio, Michigan, Wisconsin and Pennsylvania) as well as in such other GOP bastions as West Virginia, Kentucky and Arkansas. When the non-partisan Urban Institute modeled who would lose coverage under the principal Senate alternative to the ACA, it found about 80% of them lacked a college degree, 70% lived in a household with a full-time worker, and nearly 60% were white. It would be difficult to draw a more precise bulls-eye over the Trump coalition.
    Likewise, the expansion of Medicaid under the ACA that brought in millions of low income working adults has made the program essential to the non-metropolitan communities where Republicans now dominate. Because fewer rural residents have employer-provided insurance, hospitals there are often even more dependent than their urban counterparts on Medicaid. The program has also become indispensable to communities ensnared in the opioid crisis (Medicaid now pays for one-fourth of all US substance abuse treatment, up from only about one-tenth in 1986.) Yet until the Senate's final "skinny" repeal, every GOP alternative not only rolled back the ACA's Medicaid expansion but also imposed deep cuts in the underlying program.
    These ideas deeply strain the Republican coalition. One of the principal obstacles to repeal was the resistance of Republican governors from states that expanded Medicaid, particularly Ohio, Nevada, and Arizona. Rural hospitals raised some of the loudest alarms over the proposals. And polls consistently showed unease among both blue-collar and older whites over the replacement plans in general and the Medicaid cuts in particular.
    "People were paying such close attention to this health care thing and it was seen as awful, and that's particularly true among white working-class women," says Democratic pollster Stanley B. Greenberg, who has studied blue-collar white voters since the 1980s. "What he's done is gone after Medicaid and broadly health care in a way that is threatening for these women."
    Given those attitudes, Republicans may have dodged a bullet by failing to pass a sweeping repeal bill. Yet they appear determined to begin another round (or more) of Russian roulette. Not only is Trump demanding that the Senate resume its efforts at repeal. Beyond that, both the White House and House budget proposals include big cuts in Medicaid and food stamps -- even though at least half of the households receiving benefits under the Supplemental Nutrition Assistance Program in the five key Rustbelt states (Michigan, Wisconsin, Ohio, Iowa and Pennsylvania) are headed by whites without a college education, federal data show. The House budget plan goes further by proposing major cuts and structural changes in Medicare -- an idea that historically has faced overwhelming opposition from older whites. Though Trump's own budget did not propose Medicare cuts, Office of Management and Budget Director Mick Mulvaney offered initial praise for the House plan.
    The past week suggests Trump and his advisers see cultural confrontation as a vaccine against the risk his voters may recoil from these efforts to squeeze programs they rely upon. And in fact, unease about the cultural and demographic changes reshaping modern American society is virtually certain to continue binding many older and blue-collar whites to the Republican Party.
    In Quinnipiac University polling this year, blue-collar whites and seniors (of all races) were more likely than Americans overall to support Trump's original travel ban on Muslim-majority nations, his plan to build a wall along the US-Mexico border, and deportation of undocumented immigrants who have not committed a serious crime. The nonpartisan Public Religion Research Institute has found that, compared to the public overall, both groups were much more likely to say the police are not unfair to African-Americans, and the blue-collar whites were more likely to say transgender people should be required to use bathrooms that correspond with their gender at birth.
    But with Trump still receiving very low marks from minority voters, and facing historically low ratings for a Republican president among white-collar whites, he can afford hardly any defection from the blue-collar and older whites that have been his staunchest supporters. And, even with increasingly unvarnished appeals to cultural anxiety, that may be exactly what Trump is courting by renouncing his campaign pledges to defend the safety net programs that now support so many of his own voters.