Collins is exactly right. But her candor is the exception, while Conway’s lie has become standard Republican fare. On Friday, White House press secretary Sean Spicer said that Trump is “committed to making sure that no one who currently is in the Medicaid program is affected in any way, which is reflected in the Senate bill and he’s pleased with that.” Pennsylvania Senator Pat Toomey claimed on Face the Nation that “no one loses coverage” under the GOP plan. On Fox News, Wyoming Senator John Barrasso said that “the amount of dollars going to Medicaid, from today on out, continues to go up year after year after year.” (As with Conway, these deceptive comments ignore inflation and increasing population.) Republicans in the House of Representatives have taken a similar approach to their own bill:

WOW@RepTomReed on @MSNBC just now - "we don't touch Medicaid"



Clarified that he was referring to expansion, but untrue even w/that caveat — Jonathan Cohn (@CitizenCohn) June 26, 2017

The Republicans have settled on a policy of deception to weather the potential political storm over the Medicaid cuts. In theory, they should face dire consequences from constituents, given that Medicaid is a broadly popular program that provides crucial assistance to millions of people, including many who voted for President Donald Trump. But their punishment is by no means assured. In fact, recent political history suggests a more disheartening possibility: Republicans’ relentless health care lies might well work, at least long enough to do massive damage to America’s most vulnerable citizens.

In the Washington Post last week, Greg Sargent cited a Kaiser Foundation poll on public attitudes toward health care. The findings were disturbing. “[O]nly 38 percent of Americans know that the GOP plan makes ‘major reductions’ in Medicaid spending,” Sargent wrote. “Another 27 percent say it makes ‘minor’ reductions; 13 percent say it makes no reductions; and 20 percent say they don’t know. If this polling is right, that means at least 6 in 10 Americans are unaware of the central feature of the GOP plan to reconfigure one-sixth of the U.S. economy, one that will impact many millions of people over time.” The poll also found that 74 percent of Republicans think their family would be better off if Trumpcare passes.

These numbers suggest how the Republicans could pull off an amazing feat of passing a much-hated bill, with provisions that will hurt their own constituents, and survive politically. Politics in America have become so tribalized along partisan lines that it’s possible to lie on a grand scale about policy and get away with it; most Republican voters will believe whatever elected Republicans say. As Post reporter Dave Weigel observed, Karen Handel’s defeat of Jon Ossoff in the special congressional election in Georgia, where Republican ads relentlessly tied Ossoff to House Minority Leader Nancy Pelosi, “only reinforces the GOP’s sense of immunity from consequences,” one effect being that Republicans “think that whatever happens w this bill—if they face angry voters—they can paper over it w Pelosi ads.” And if Trumpcare does cause misery in the coming years, everything can be blamed on Obamacare, which might convince enough Republican voters to help keep Congress under GOP control.