President Trump speaks at a rally in Cedar Rapids, Iowa, on June 21. (Charlie Neibergall/AP)

Donald Trump set himself apart from other Republican presidential candidates when it came to health care. Before taking office, he vowed “insurance for everybody” that would be “much less expensive and much better” and explicitly promised not to touch Medicaid, which millions of his working-class supporters rely upon to cover doctor’s visits and medication.

But as Republicans in the Senate press ahead with legislation that would dramatically cut Medicaid and scale back the Affordable Care Act marketplaces, it is increasingly clear that President Trump is almost certain to fall well short of fulfilling those promises.

Trump and congressional Republicans will likely hail any bill that reaches the president’s desk as the fulfillment of a long-standing pledge to “repeal and replace” the ACA, former president Barack Obama’s signature health-care law. But if the House and Senate agree on legislation along the lines of what is now being debated, millions including some of Trump’s most ardent supporters are projected to lose coverage, receive fewer benefits or see their premiums rise.

And if the health-care push stalls or falls apart, the president who campaigned for the White House as the ultimate dealmaker will be dealt a serious political blow — another example of Trump’s inability to move major legislation through Congress.

“He’s going to own it either way, whether he signs a bill or doesn’t get a bill,” said Michael Steele, the former chairman of the Republican National Committee. Steele said passage of the legislation could hurt Trump politically as much as its failure. “You’re going to have a whole generation of people who had health care losing health care, and in many instances, they’re Trump voters. I think that’s a very risky play.”

In a television interview broadcast Sunday, Trump acknowledged that he had called the House bill “mean” weeks after celebrating its passage in the Rose Garden. He suggested other changes could be coming to the Senate bill unveiled last week to ease its impact on lower-income Americans, but Trump said “we have a very good plan” that he characterized as close to passing.

“Healthcare’s a very complicated subject from the standpoint that you move it this way, and this group doesn’t like it,” Trump said on FOX News’s “Fox & Friends.” “You move it a little bit over here, you have a very narrow path.”

One bright spot for Trump is that many of his most die-hard backers echo the president in largely blaming others for continued gridlock in Washington. At least for now, many believe he would fulfill his promises on health care and other priorities if only given the chance.

Charlene Beatty, 71, who lives on a farm in eastern Iowa and attended Trump’s rally last week in Cedar Rapids, said Congress needs to stop obsessing over the investigation into Russian meddling in the 2016 election and accomplish some of the things Trump has asked the lawmakers to do — including reforming health care.

“Just leave him alone, and he’ll do a lot of good,” she said.

GOP senators say their bill took steps to rectify some issues in a House version of the bill, which would cause 23 million people to lose health-care coverage by 2026, according to an analysis by the nonpartisan Congressional Budget Office.

Still, lawmakers expect that a new projection from the CBO as early as Monday will show millions losing insurance under the Senate version. too.

That means that managing expectations could be one of Trump’s biggest challenges in coming weeks.

Many Republicans, even those supportive of the effort to “repeal and replace” the ACA, view it as only a starting point for fixing the problems facing the…