Republicans — including Trump — campaigned for years on a lie. They knew it was a lie, but it was an enraging one that excited their base: Obama was destroying America’s health care system, but Republicans could undo the damage and replace it with their own, better bill.

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First, Obama wasn’t destroying America’s health care system. To the contrary, he simply sought to make it cover more people. He moved to take American health care in a more humane, modern and civilized direction, to make it more universally accessible, even by the sick and poor who often took its absence as a given.

Second, the Republicans had no replacement plan that would cost less and cover as many or more people. That could not be done. So, their repeal-and-replace efforts failed. But that also meant that Trump’s promise was proven a lie. Trump has no problem lying, but in the end he wants his lies to look plausible.

Trump makes assertions for which there is no evidence — either knowingly lying, recklessly boasting or wishfully thinking — then seeks support for those statements, support that is often lacking because the statements are baseless.

He violates a basic protocol of human communication: Be sure of it before you say it. His way is to say something wrong, then bend reality to make it appear right. This is why the age of Trump is so maddening and stupefying: He is warping reality.

Last week he took more swipes at undermining the A.C.A.: Asking his administration to find ways to increase competition among insurers (a move many worry will move younger, healthier people out of the marketplace) and stopping the so-called “cost-sharing reduction” (CSR) payments — federal subsidies paid to insurance companies to help finance coverage for low-income Americans (a move many believe will send premiums soaring for those people).

Trump is doing this even though it will likely wreak havoc on countless lives. He is doing this even though a Kaiser Health Tracking Poll released Friday found that most Americans want Trump and Congress to stop trying to repeal the law, and instead work on legislation to stabilize the marketplaces and guarantee health care to Americans.