President Trump misrepresented his administration’s health care record while disputing the premise of a campaign ad by Democratic presidential candidate Michael Bloomberg.

“Mini Mike Bloomberg is spending a lot of money on False Advertising,” wrote Trump in a series of tweets Monday morning. “I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now, while at the same time winning the fight to rid you of the expensive, unfair and very unpopular Individual Mandate and, if Republicans win in court and take back the House of Represenatives, your healthcare, that I have now brought to the best place in many years, will become the best ever, by far. I will always protect your Pre-Existing Conditions, the Dems will not!”

Trump’s “win in court” reference is about a lawsuit, backed by the Justice Department, that if successful would result in the overturning of the Affordable Care Act (the ACA, or Obamacare). If that happens, many Americans with preexisting conditions could lose their coverage entirely or face significantly higher premiums, unless and until an alternative is passed. Without protections for preexisting conditions provided by Obamacare, the Kaiser Family Foundation estimated in 2015 that up to 52 million people could be denied coverage. Others would lose insurance if the Medicaid expansion that was adopted by dozens of states and D.C. was killed. A full repeal with no immediate replacement plan could also hurt the fight against opioid addiction and HIV.

President Trump and Michael Bloomberg. (Photo illustration: Yahoo News; photos: AP, Rick Wilking/Reuters)

Republicans insist they want to pass a plan that requires insurers to offer coverage for preexisting conditions, but analysts consider that meaningless without a mechanism to control or subsidize premiums. Insurers will not, on their own, cover people with predictable medical expenses at a price that guarantees they will lose money. That was the problem the ACA sought to address with its controversial individual mandate, which was meant to spread the cost of insurance over a broader base that would include healthy people. That mandate was repealed in the 2017 Republican tax bill.

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Bloomberg’s campaign has been running an ad that characterizes Trump’s plan as “repealing Obamacare, threatening coverage for millions of Americans.”

Trump promised “the best [health care] ever, by far” if Republicans retake the House, but in the first two years of his term, the GOP did have control of the House of Representatives and made a sustained effort to replace Obamacare with a new plan. The Congressional Budget Office (CBO) found in March 2017 that the American Health Care Act (AHCA), their proposed replacement, would have knocked 14 million people off insurance in one year and 24 million more by 2026, while the AARP estimated it would raise health care costs for older Americans by thousands of dollars. The Republican House passed an amended version of the AHCA in May 2017, leading to a Rose Garden celebration with Trump and then-House Speaker Paul Ryan, but it died in the Senate. The legislation would have slashed Medicaid for low-income Americans, despite Trump’s repeated promises to the contrary.

The July 2017 “skinny repeal” vote that barely failed in the Senate following “no” votes from Republican Sens. Susan Collins, Lisa Murkowski and John McCain was estimated by the CBO to result in 16 million more uninsured Americans by 2026 and a 20 percent rise in premiums. Actuaries calculated that thousands more Americans would have died sooner if the Obamacare replacements had passed.

Trump has promised the best health care plan with no real details since the early days of his campaign. Trump began making the promises in a September 2015 interview with “60 Minutes,” making vague promises when pressed by Scott Pelley on how he would fix it.

“There’s many different ways, by the way,” said Trump. “Everybody’s got to be covered. This is an un-Republican thing for me to say because a lot of times they say, ‘No, no, the lower 25 percent that can’t afford private.’ But —”

“Universal health care?” interjected Pelley.

“I am going to take care of everybody. I don’t care if it costs me votes or not,” said Trump. “Everybody’s going to be taken care of much better than they’re taken care of now.”

“The uninsured person is going to be taken care of how?” asked Pelley.

“They’re going to be taken care of. I would make a deal with existing hospitals to take care of people. And, you know what, if this is probably —”

“Make a deal?” asked Pelley. “Who pays for it?”

“The government’s gonna pay for it,” promised Trump. “But we’re going to save so much money on the other side. But for the most it’s going to be a private plan, and people are going to be able to go out and negotiate great plans with lots of different competition with lots of competitors with great companies and they can have their doctors, they can have plans, they can have everything.”

“We’re going to have insurance for everybody,” he reiterated in a January 2016 interview with the Washington Post. “There was a philosophy in some circles that if you can’t pay for it, you don’t get it. That’s not going to happen with us.”

Upon taking office, Trump continued to make promises of a hypothetical ideal health care plan.

“We have a plan that I think is going to be fantastic. It’s going to be released fairly soon,” Trump said after a February 2017 meeting with health insurers. “I think it’s going to be something special. … I think you’re going to like what you hear.”

The following day, he pointed out something that those who have worked on health care policy have known for decades: It’s extremely complicated.

“We have come up with a solution that’s really, really I think very good,” Trump said. “Now, I have to tell you, it’s an unbelievably complex subject. Nobody knew health care could be so complicated.”

In a March 2019 interview with Fox News, Trump again promised “incredible health care that the Democrats, frankly, wouldn’t know how to do.”

The former New York City mayor’s campaign account retweeted Trump’s Monday morning rebuttal with “@ us next time.” The billionaire has spent tens of millions of his personal fortune on television advertising targeting Trump and has promised to continue spending through the general election even if he is not the Democratic nominee.

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