“WE’RE GOING to have insurance for everybody,” President Trump told The Post in January. “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.” Yet that is exactly the direction Republicans appear to be heading.

In his first speech to a joint session of Congress, Mr. Trump stressed providing “access” to coverage rather than re-articulating the goal of insuring everyone, embracing rhetoric Republicans have used to defend policies that would likely reduce the number of Americans with decent health-care coverage. The president then seemed to endorse the broad outlines of the sorts of repeal-and-replace schemes that mainstream Republicans such as House Speaker Paul D. Ryan (Wis.) have backed.

It may still be too early to say what Mr. Trump really favors. The White House says he will release a proposal within the next few weeks. Yet the president’s thinking on health care has long been scattered. During and after the campaign Mr. Trump condemned both high deductibles and high premiums, seemingly promising to lower both. In fact, these two figures generally move in opposite directions, and only spending massive amounts of federal money would change that. Tuesday night, he called for a fantasy plan that would “expand choice, increase access, lower cost, and at the same time provide better health care.”

Certainly, Republicans have not proposed any such magical plan. A fair reading of every major Republican replacement plan so far — including the one the president’s Health and Human Services secretary authored and the one that Mr. Ryan proposed last summer — would reduce access to decent coverage.

The latest example is a draft bill circulated among lawmakers in Feburary and leaked at the end of last week. Though a new draft is apparently under discussion, the February plan tracks with earlier Republican proposals, which is to say that it adjusts benefits toward healthier and wealthier people, even at the risk of leaving low-income Americans out of the system.

Though the bill contains some attractive provisions, such as limiting irrational tax breaks for employer-sponsored health insurance, it makes several cardinal errors. Obamacare linked the federal subsidies that health-care consumers get to people’s incomes. The GOP would break this link, showering benefits on wealthy insurance-buyers who do not need them and shortchanging poorer people who may well find themselves unable to afford adequate coverage.

The bill would double down on this problem by stressing tax-advantaged health savings accounts to fill coverage gaps, but these accounts would be useless to those without spare income with which to fill them. To catch those who fall through the cracks, the bill would provide states “innovation grants” to set up high-risk pools, create reinsurance programs or other such things. Yet high-risk pools serially failed to serve as adequate backstops in the pre-Obamacare years.

As Mr. Trump belatedly noted the other day, health-care policy is complex. But the essential questions facing Republicans remain simple. Will as many or more people be covered under an Obamacare replacement plan? Can the GOP make such a commitment without severely degrading coverage quality? So far, Republicans have the wrong answers.