One reason these types of attacks can work (they did not, in her case, obviously), is that Republicans correctly think they can usually get some number of journalist-friendly Democrats and centrist dipshit pundits to echo their attacks.
You know, some "moderate" member of Congress in Ohio, or wherever, will go on TV and say that while he supports the Speaker, he hopes she leaves her gay-loving, tree-hugging, tax-raising impulses back in San Francisco with the rest of those weirdos. Political reporters will write 27 articles wondering if America is ready for San Francisco values. The (old) New Republic runs a cover story (written and edited by Harvard grads) about the ongoing coastal elitist problem of the Democrats.
As I said, that didn't play out that way with Pelosi, much, even though they tried. But my point is that Republicans can only dangle the bait and the various fishies have to bite.