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Trump and health care: Promises made, promises broken

Donald Trump promised universal health coverage, lower costs, and no Medicaid cuts. He's betraying those Americans who actually believed Trump's assurances

At a campaign rally in Iowa this week, Donald Trump boasted, "One by one we are keeping the promises we made to the people of Iowa and the people all over our country." That's hopelessly bonkers on a wide variety of fronts, but it's especially striking when it comes to health care.

The president promised the American public, "We're going to have insurance for everybody.... Everybody's going to be taken care of." He vowed his health care policy would offer "lower premiums" with "much lower deductibles." And perhaps most importantly, Trump swore, over and over again, in writing and in public remarks, that he would never cut Medicaid.

And yet, there was the Republican president yesterday, throwing his support behind a Senate GOP bill that won't cover everybody, would increase consumer costs, and cuts Medicaid by hundreds of billions of dollars. As NBC News' Benjy Sarlin explained:

The Affordable Care Act gave states federal funding to expand Medicaid coverage to people whose incomes were between 100 percent and 138 percent of the federal poverty line.... But [the Senate Republicans' plan] would go a lot further than repealing Obamacare's changes. It would also cap the amount of funding states can get on a per-recipient basis rather than continue the current system, in which states decide how much to spend and then have the federal government match their contribution.Starting in 2025, the plan would then grow those per-recipient caps at a rate that's unlikely to keep pace with increasing medical costs. A similar change in the House bill was projected to reduce Medicaid spending by $839 billion over a decade and cover 14 million fewer people. The Senate bill kicks in later, but its cuts would be even deeper than the House plan.

This is a profound betrayal to those Americans who actually believed Trump's assurances, and voted for him because they expected the Republican to honor his word.

What's the White House's explanation for the presidential perfidy? Trump's budget director recently questioned the importance of the Medicaid promise, which probably won't offer much comfort to families poised to suffer.

What's more, it's not just Trump.

Sen. Dean Heller (R-Nev.) recently said, before he knew about his party's plans to gut Medicaid, "We cannot pull the rug out from under states like Nevada that expanded Medicaid." Sen. Lisa Murkowski (R-Alaska) has made similar comments, as have other GOP senators.

It's against this backdrop that a Senate Republican quote to the Huffington Post yesterday stood out for me.

Although he didn't formally endorse the legislation, it's clear how Sen. Tim Scott (R-S.C.) would vote. Low-income people would have "more access" to health care because of the bill, he claimed. Asked how those sorts of people would have more access if the measure would result in Medicaid cuts, Scott offered a complete mischaracterization of the bill."Medicaid's not actually being cut from our perspective," he said.

I realize policymakers will have spirited conversations about the nuances of expenditure growth rates, but whether or not Medicaid is being "cut" isn't exactly a matter of "perspective." Either Republicans intend to spend less or they don't. Opinions and debates over how many Medicaid patients can dance on the head of a pin aren't altogether constructive.

And regardless of the right's "perspective," the pending Republican legislation would cut Medicaid dramatically, promises from GOP politicians notwithstanding.