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Pressed on the ACA, Trump's rhetoric takes an incoherent turn

Trump was asked how he reconciles trying to kill the ACA while promising to protect those with pre-existing conditions. His answer didn't go well.
Image: President Donald Trump listens during a FOX News Channel town hall at the Scranton Cultural Center
President Donald Trump listens during a FOX News Channel town hall at the Scranton Cultural Center, Thursday, March 5, 2020, in Scranton, Pa.Evan Vucci / AP

A few weeks ago, Health and Human Services Secretary Alex Azar told senators that the Trump administration would come up with a health care plan -- eventually. The cabinet secretary specifically testified that once the Supreme Court makes its "final judgment" on the Affordable Care Act, then the White House would release a plan.

A week earlier, White House Budget Director Russell Vought added that the president and team will have a plan to protect Americans with pre-existing conditions, even if "Obamacare" is destroyed, and even if it's not reflected in the administration's latest budget. "The president is working on his own plan that we're not yet ready to reveal," Vought said. "It will be fully reflected in what he comes forward with."

Sure, this was a vague line that was difficult to take seriously, but that's what he said.

It was against this backdrop that Donald Trump participated in a Fox News town-hall meeting last night, and was asked a similar question: the president is both promising to protect Americans with pre-existing conditions while at the same time asking the courts to end protections for Americans with pre-existing conditions. How does Trump reconcile this? This was his full response, according to the official transcript:

"We want to terminate Obamacare because it's bad. Look, we're running it really well, but we know it's defective. It's very defective. We got rid of the worst part. And that was a very important thing. You know getting rid of the individual mandate was a very important thing. But we want to get something -- if we can get the House, you'll have the best health care and health insurance anywhere on the planet. But we have to get the House back. Now, that means we have to hold the Senate. We have to get the House. We have to, obviously, keep the White House. But, what we're doing is managing it really well. Now, it's a case; it's called Texas vs. -- you understand -- it's Texas who is suing. They want to terminate it. But everybody there is also saying, and everybody -- we have our great senator from Pennsylvania. Thank you very much, Pat, for being here. And Pat Toomey. And -- but, very important -- and our -- by the way, our great congressmen, I have to say, they were warriors. Right? Real warriors, in terms of the fake impeachment. I will tell you that. But, so Texas is trying -- and it's Texas and many states -- they're trying to terminate, but they want to put something that's much better. They're terminating it to put much better. And they've all pledged that pre-existing conditions, 100 percent taken care of."

At that point, the hosts changed the subject, which was a shame, because I had some follow-up questions, starting with, "Huh?" Even for a president who tends to ramble, this was incoherent.

Digging through this, though, there were some notable elements. Trump seemed to hint, for example, at a passing of the buck: note how many times he referenced Texas and its state-based partners, as if the case threatening the health care system has nothing to do with his administration. In reality, Republican officials at the state level filed the case, but it was the Trump administration that has helped champion it, including asking the courts to side with Texas and its co-litigants in order to tear down the ACA in its entirety.

Also note that the president didn't even try to answer the question posed to him. It wasn't altogether clear if he even understood what he was being asked.

But perhaps most striking was Trump's boast that if Republicans controlled the House, Senate, and White House, GOP officials would deliver "the best health care and health insurance anywhere on the planet." He went on to say, in reference to the current system, "What we'd like to do is totally kill it, but come up -- before we do that -- with something that's great."

And for those who have no memory of 2017 and 2018, this promise may even make sense.

But for the rest of us, 2017 and 2018 was an era in which Republicans controlled all of the levers of federal power, kicked around several regressive alternatives to the Affordable Care Act, each of which were wildly unpopular and would've done drastic harm to millions of American families. Eventually, after multiple attempts, Trump and his allies failed spectacularly to "repeal and replace" the existing system.

Now, the president is effectively saying, "We may have screwed up before, but this time we'll get it right with a plan I'm not prepared to share."

It was exactly 10 years ago this month when President Barack Obama put his signature on the Affordable Care Act. A full decade of false starts and false promises later, Republicans are still making vague assurances about coming up with a superior alternative.

Taking such promises seriously is unwise.