Even amid an era of American politics rife with absurdities, President Donald Trump’s posturing as a champion for people with preexisting medical conditions stands out.

Trump — who in 2017 pushed health care legislation that would’ve resulted in 23 million Americans losing coverage, and whose administration is currently fighting in federal court to strike down the Affordable Care Act (ACA), including its protections for people with preexisting conditions — nonetheless claimed in a tweet attacking Democratic presidential candidate Michael Bloomberg on Monday that “I was the person who saved Pre-Existing Conditions in your Healthcare, you have it now.”

Alluding to the aforementioned lawsuit, Trump went on to write that “if Republicans win in court and take back the House of Represenatives [sic], 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!”

....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! — Donald J. Trump (@realDonaldTrump) January 13, 2020

Trump’s tweet is either a big lie, illustrates his profound confusion about health care policy, or some combination thereof.

As I’ve written before, when Trump has been asked basic questions about health care — such as “what is your health care plan, sir?” — he’s typically responded with lengthy, incoherent word salads. The possibility Trump knows so little about health care policy that he actually believes he saved protections for preexisting conditions can’t be ruled out.

But while Trump might be confused about health care, the Justice Department and Republican state attorneys general who are party to the lawsuit the president referred to — which seeks to strike down the ACA — seem to be seeing things more clearly.

As Katelyn Burns wrote for Vox, Republicans filed a brief on Friday asking a federal court court to not take up the ACA case until after the 2020 election. That move suggests Republicans are well aware that their unceasing push to take health care away from people is a political loser this year, just as it was during 2018’s blue wave election. (The Urban Institute estimates about 20 million people would lose coverage if the Republican lawsuit is successful.)

While Trump’s efforts to repeal the ACA have been unsuccessful, he has presided over a significant increase in the rate of uninsured people in the country. His health care proposals have consistently sought to strip legal protections and coverage from people. And yet he is refusing to let reality stop him from posturing as something he clearly isn’t — or making empty promises about what will happen if Republicans retake control of the House following this November’s elections.

Trump goads the crowd into booing John McCain for voting against ACA repeal pic.twitter.com/0yDzu8Tjb6 — Aaron Rupar (@atrupar) April 29, 2018

Trump’s Monday morning tweets were in response to ads Bloomberg has been running hitting him on health care. Bloomberg, and Democrats more broadly, seem to realize that health care is an issue in which they can draw a clear contrast with Trump. The Republican brief that was filed on Friday came in response to Democratic attorneys general petitioning the court to take up the preexisting conditions case on an expedited basis.

As Burns wrote:

If the Supreme Court were to uphold the ACA, Democrats would be able to campaign as the party that defended Obamacare. If it were to be overturned, then Democrats would cast the GOP as the party that dumped 20 million people off their health insurance in an election year. It is in Republicans’ best interests to avoid that lose-lose scenario, and therefore they have asked the court not to take up the case in the first place.

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