Candidate Donald Trump wanted to make sure you have health insurance. President Donald Trump is committed to taking it away.

During his presidential campaign, Trump told 60 Minutes, “I am going to take care of everybody.” On the campaign trail in 2018, he sounded similar. “We will always protect Americans with preexisting conditions,” he said at an event in Philadelphia just before the midterm elections.

Republicans will totally protect people with Pre-Existing Conditions, Democrats will not! Vote Republican. — Donald J. Trump (@realDonaldTrump) October 24, 2018

But in office, Trump has attempted to implement an agenda that does the opposite. He’s backed legislation, regulations, and lawsuits that would make it harder for sick people to get health insurance, allow insurance companies to discriminate against patients with preexisting conditions, and kick millions of Americans off the Medicaid program.

This week, his Justice Department filed a legal brief arguing that a judge should find Obamacare unconstitutional — a decision that would turn the insurance markets back into the Wild West and eliminate Medicaid coverage for millions of Americans. By at least one estimate, a full repeal could cost 20 million Americans their health care coverage.

The morning after the filing, Trump went back to campaign mode, attempting to sound like his administration has a different agenda.

The Republican Party will become “The Party of Healthcare!” — Donald J. Trump (@realDonaldTrump) March 26, 2019

Candidate Donald Trump and President Donald Trump have really different views about how the American health care system ought to work — and for patients who rely on the Affordable Care Act, the difference between which of those platforms gets implemented could be a matter of life or death.

Trump’s position on health care, explained

President Trump has a lengthy history of promising voters a health care system that provides for all Americans — a position he hasn’t ever tried to achieve since taking office.

Shortly before his inauguration, Trump gave an astonishing interview to the Washington Post. The president-elect told the newspaper that he was nearing completion of a plan that would provide “insurance for everyone.”

“It’s very much formulated down to the final strokes. We haven’t put it in quite yet but we’re going to be doing it soon,” Trump continued.

Sitting in the press gallery of the Capitol building, surrounded by other health policy reporters reading the same article, the buzz began: What would this plan look like? When would we see it?

We still lived in a world where, when a president promised a policy plan, you generally expected to see one.

With the benefit of hindsight, the real answer to all our questions now seems obvious: There was no plan. There would never be a White House plan.

It’s understandable why the health care policy press thought there just might be. He gave an interview to 60 Minutes’s Scott Pelley promising to repeal the Affordable Care Act and replace it with something much better. Here’s the key part:

DONALD 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 — SCOTT PELLEY: Universal health care? DONALD TRUMP: I am going to take care of everybody. I don’t care if it costs me votes or not. Everybody is going to be taken care of much better than they’re taking care of now. SCOTT PELLEY: The uninsured person is going to be taken care of how? DONALD TRUMP: They’re going to be taken care of. I would make a deal with exiting hospitals to take care of people. And, you know, if this is probably— SCOTT PELLEY: Make a deal? Who pays for it? DONALD TRUMP: The government’s gonna pay for it.

Instead, Trump fell back on the old repeal-and-replace proposals that had circulated around Congress for years. Instead of providing universal health care, these proposals would result in millions of Americans losing coverage and premiums spiking by as much as 850 percent for low-income, elderly Americans.

In Trump’s first year in office, congressional Republicans spent a year attempting to repeal the Affordable Care Act and replace it. They rolled out a number of replacement plans. The bill that got furthest, the American Health Care Act, 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. Ultimately, Republicans in Congress failed. Obamacare survived.

The Trump administration didn’t stop there. It rolled out new regulations that were expected to 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 he has let state Medicaid programs require beneficiaries to work, a move that has led to thousands of low-income Arkansans losing coverage.

But perhaps Trump’s most revealing move is supporting a lawsuit that would eliminate Obamacare completely.

Trump is asking the federal courts to end Obamacare and leave millions uninsured.

In early 2018, a coalition of conservative attorneys general filed a lawsuit arguing that Congress’s new tax package — and its elimination of the fine for not carrying health insurance — makes the entirety of Obamacare unconstitutional (you can read more details about the legal argument here).

Usually, a presidential administration defends current law, but the Trump administration took a different approach in this case. Last June, it agreed with the conservative states that the mandate and, with it, the law’s rules that prohibit insurers from denying people health insurance or charging them higher rates, should be found unconstitutional.

At the time, the Trump administration wasn’t fully endorsing the challengers’ view. It didn’t agree, for example, that the Medicaid expansion — which covers millions of low-income Americans — would need to fall if the mandate fell. Instead, the Trump administration argued that the parts of Obamacare with the strongest policy connections to the mandate (the ban on preexisting conditions, the requirement to offer coverage to all shoppers) would need to be struck down as well.

What the Trump administration did yesterday goes much further. Now, the government is arguing that the court should find the entirety of Obamacare unconstitutional. This would mean repealing everything from the Medicaid expansion to the provision that allows young adults to stay on their parents’ insurance until they turn 26.

If the courts does what the Trump administration wants, an estimated 19.9 million Americans would lose their health insurance coverage. The number of people who lack health insurance in Kentucky would rise by 151 percent, according to data from the nonprofit Urban Institute. In Montana, the number of uninsured would rise by 176 percent.

In fitting fashion, Donald Trump followed up the news with a tweet touting his party’s position on the issue:

The Republican Party will become “The Party of Healthcare!” — Donald J. Trump (@realDonaldTrump) March 26, 2019

Trump’s position on health care matters to voters. But he isn’t telling the truth about it.

President Trump isn’t telling the truth about his position on health care because his actual position, it turns out, isn’t very popular. Americans like the idea of making sure sick people have access to health insurance.

The Kaiser Family Foundation has found that it was the most important health care issue going into the election. For 14 percent of Americans, it was the “single most important” factor heading into the voting booth.

I saw this firsthand two years ago, when I went to Kentucky to write a story about Obamacare enrollees who voted for Trump. I asked a lot of voters: Why did you support the candidate who campaigned on getting rid of your health insurance?

I heard the same answer again and again: He promised that something better would come along. The voters I met during that reporting trip had paid attention to the election. They knew that Trump wanted to repeal Obamacare. But they also listened to the promises that came after that: His repeated claims that he would come up with something better to replace it.

Americans are listening to the claims Trump makes about health care. They are hearing him say he wants “insurance for everyone.” They listen when he says he has a plan.

But everything I’ve seen covering the Obamacare repeal debate — from the bills on Capitol Hill to this lawsuit filing— tells me that Trump is not interested in protecting preexisting conditions. There isn’t a plan to create coverage for everybody, and there never will be.

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