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Why Trump's lie about pre-existing conditions was so striking

Even among a blizzard of lies, Trump's State of the Union claim about protecting Americans with pre-existing conditions stood out as breathtaking.

There's no shortage of excellent fact-check reports on Donald Trump's latest State of the Union address, and the president certainly kept the fact-checkers busy with a blizzard of obvious falsehoods. But one had me smacking my forehead just a little harder than the others.

From the official transcript:

"I've also made an ironclad pledge to American families: We will always protect patients with pre-existing conditions."

I don't doubt that some people will fall for this. Indeed, congressional Republicans applauded the line last night, as if Trump were telling the truth. But he wasn't, and reality on this point is unambiguous.

To be sure, the president is clearly fond of this lie. Given the frequency and apparent sincerity with which he repeats the lie, part of him may actually believe it. It was several weeks ago, for example, when the Republican claimed on Twitter, "I was the person who saved Pre-Existing Conditions in your Healthcare." He added, "I will always protect your Pre-Existing Conditions, the Dems will not!"

When that faced immediate pushback, and the president's brazen deception was exposed, he doubled down, publishing another tweet repeating the lie: "I stand stronger than anyone in protecting your Healthcare with Pre-Existing Conditions."

As we discussed at the time, however, Trump's line was, and is, the opposite of the truth. He didn't "save" protections for Americans with pre-existing conditions -- protections created by Barack Obama's Affordable Care Act -- the Republican fought to take those protections away through a series of far-right repeal-and-replace proposals he couldn't get through a Congress led by his own party.

Those efforts are ongoing: Trump is also helping champion a federal lawsuit, which is currently pending in the courts, and which would strip protections from Americans with pre-existing conditions.

That's not opinion; it's reality. Even for a president known for lying to the point that observers have questioned his mental stability, this is as offensive a lie as any Trump has told.

The question is whether he'll get away with it. NBC News' Benjy Sarlin did a nice job recently explaining a realistic scenario that may very well unfold in the coming months. The scenario involves Trump and his team urging the courts to end protections for Americans with pre-existing conditions, falsely telling voters that Trump actually wants to save those protections, winning re-election in part thanks to his transparent lie, and then waiting for Trump-appointed Supreme Court justices to eliminate those protections in the Republican's second term.

Could that happen? Of course it could. And that, in a nutshell, helps capture the rationale behind the deception. Trump knows his health care agenda is wildly unpopular, just as he knows there's broad, bipartisan support for some of the core benefits in "Obamacare." The president doesn't want to give up his crusade against the popular reform law, and he doesn't want to lose.

The result is a dynamic in which Trump feels he has no choice but to play Americans for fools.

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