Since he is unburdened by either integrity or any actual beliefs about most policy issues, President Donald Trump is free to say just about anything about what he has done or will do. Like this howler from Monday morning:

"Mini Mike Bloomberg is spending a lot of money on False Advertising. 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 ..."

What's notable here isn't the lie that "I was the person who saved Pre-Existing Conditions in your Healthcare." He didn't, of course -- in fact, it was the Affordable Care Act that for the first time protected people with preexisting conditions, and Trump tried to repeal the ACA in Congress and now supports a lawsuit that would overturn that law root and branch.

No, what's interesting is that he feels the need to make this preposterous claim. Trump obviously understands that for all Republicans' dark warnings about how the Democrats' Medicare-for-all idea would force you to use a government-issued home leech kit for all your medical needs and this will destroy their chances in the next election, this is an issue where Republicans remain tremendously vulnerable.

Regardless of the details of whatever discussion we're having about health care at a particular moment, much of the public begins with the default assumption that Republicans have bad motives and want to make things worse, an assumption amply supported by history.

But when Trump claims that "I was the person who saved Pre-Existing Conditions in your Healthcare," his lie is only slightly more laughably obvious than what your average Republican says about this issue.

Consider, for instance, Sen. Josh Hawley, R-Mo. When he ran for the Senate in 2018, he aired soft-focus ads pledging that he'd always protect people with preexisting conditions. He didn't mention that as the state's attorney general at the time, he was one of the prime sponsors of the lawsuit that sought to strike down the ACA and remove that protection (when pressed he would say that he supported eventually replacing the ACA with some unspecified law at some point in the future that would duplicate its protections).

That was in fact not a new dynamic: We've watched for years as Republicans sought to cut or privatize Medicare, then when election time rolls around they proclaim themselves the program's greatest defenders.

That lawsuit has been working its way through the courts, which made the administration realize the danger that they might actually succeed. Imagine if in the heart of the presidential campaign, the Supreme Court did what Republicans asked and struck down the ACA.

With a stroke of a pen there would be no more protection for preexisting conditions, not to mention the fact that tens of millions of people who benefited from the expansion of Medicaid would lose their health coverage, millions more would lose subsidies that allow them to afford insurance, and a whole system of regulations under which the health care industry has been operating for years would vanish.

The result would be chaos, huge amounts of suffering and anxiety, and - this is the part that has Republicans really worried - a political cataclysm for them. Which is why the Trump administration just took the unusual step of begging the Supreme Court not to rule on their own lawsuit any time soon.

Even if the ACA is upheld and Trump is reelected, it's safe to say he has lost his appetite for any legislative assault on the law. The truth is that he doesn't have the interest or the patience to do any kind of policymaking on health care; as he said when he tried to repeal the ACA the first time, "Nobody knew health care could be so complicated." In fact, everyone except for him knew it perfectly well. But he knows it now.

However, that should not obscure the fact that Trump installed at the Department of Health and Human Services a cadre of extremist ideologues who seek every day to undermine government's role in guaranteeing health security.

They'll be working busily away even if there are no big new health care initiatives from the Trump White House or Republicans in Congress. But Trump can't help himself; like a TV executive hyping a fall program that's not actually in production, he periodically says they're about to release a great new health care plan, leading to Republicans to wonder what he's talking about and how much they need to pretend he didn't just pull it out of thin air. Like the time last March he announced grandly that Republican senators would soon be unveiling the GOP's new plan, and "They are going to come up with something really spectacular." Needless to say, they came up with a spectacular nothing.

One thing is for sure: Health care will figure prominently in this year's election, and Trump knows that one of the only cards he has to play is to lie pathetically about what he has done and what he intends to do. By now it's hard to imagine too many voters will be fooled.

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