President Trump used his State of the Union address to lay out a seemingly straightforward health care agenda. He described two major priorities: to lower drug prices and “to protect patients with preexisting conditions.”

What Trump didn’t say: His administration thinks the Affordable Care Act’s protections for preexisting conditions are illegal and ought to be ruled unconstitutional.

The Affordable Care Act bars health insurance plans from discriminating against Americans with preexisting conditions. Insurers are required to provide coverage to all patients at an equal price, without asking for information about their medical history.

But conservative attorneys general are challenging that part of Obamacare. They have brought a case in federal court that argues Obamacare is no longer constitutional after Congress’s repeal of the individual mandate.

The challengers had an early victory late last year when a Texas judge ruled in their favor, sending the lawsuit up to the Fifth Circuit Court of Appeals.

Trump’s Department of Justice has sided with these conservative attorneys general. In June, it filed a legal brief in the case asking the judge to strike down Obamacare’s ban on preexisting conditions.

This was unusual: The federal government typically defends federal law. It usually does not ask a court to overturn it. Because of the Trump administration’s actions, a coalition of liberal attorneys general who support the Affordable Care Act have had to step in and defend the law — playing the role that the federal government typically would.

Trump’s hypocrisy on preexisting conditions

There are some policy debates where it’s difficult to figure out where different candidates stand. For example, I don’t know what candidates really mean when they say they support “Medicare-for-all.” The term is shorthand for a universal coverage system, but what that system looks like exactly can vary.

The debate over preexisting conditions isn’t like that. It is a debate where we have lots and lots of evidence of where Trump and others stand.

Trump has repeatedly supported legislation, regulations, and lawsuits to make it harder for sick people to get health insurance.

Most obviously, he backed Republican efforts to repeal the Affordable Care Act, replacing it with the American Health Care Act. That bill would have reopened the door for insurers to charge sick people higher premiums — and to stop covering the health law’s essential health benefits, a requirement in Obamacare that made sure more insurance plans covered more of the basics.

Less publicly, the Trump administration has pushed forward regulations that will drive up premiums for sicker Americans. He has widened the availability of skimpy “short-term” plans that are allowed to not cover prescription drugs, maternity benefits, or people with preexisting conditions.

And, as I mentioned earlier, Trump’s most brazen move is supporting a lawsuit that would eliminate Obamacare’s preexisting condition protections completely.

Let that sink in for just a moment. President Trump used his State of the Union to describe protecting patients with preexisting conditions as a top priority. But that is just not the position of his White House, full stop. If the federal court sides with the Trump administration, protections for Americans with preexisting conditions would cease to exist.

The world that President Trump has pushed for — in federal regulations, in congressional legislation, in legal filings — is undeniably a world in which it is harder for the Americans who need health insurance to get access to it.