At his ABC News town hall on Tuesday, President Trump repeated two lies he tells whenever health care comes up: That he will protect those with preexisting conditions while Democrats won’t, and that he is about to release an extraordinary new health-care plan that everyone will love.

Though Trump may have been operating on autopilot, it was a good reminder of what the next four years will look like if he is reelected.

As we’re forced to keep repeating, Trump will not protect those with preexisting conditions: Those protections originate with the Affordable Care Act, which Trump tried to repeal with legislation and is now attempting to get the Supreme Court to strike down.

But his second lie — the phantom Trump health-care plan, always mere weeks away — is more directly relevant to the question of what will happen in the future.

“We’re going to be doing a health-care plan very strongly and protect people with preexisting conditions,” Trump said. When host George Stephanopoulos pointed out that Trump has said he was about to release a plan on many previous occasions, Trump replied, “I have it all ready, and it’s a much better plan for you.”

I shouldn’t have to say that he has nothing “all ready,” and it will not be better for anyone. But I do.

Health care, it should be clear by now, is one of the many policy issues about which Trump couldn’t care less. There are, however, people in his administration who do care. Their efforts are driven in a single direction: to take government-provided health coverage away from as many people as possible, and to remove restrictions on insurance companies so they can do things like sell “junk insurance” plans that offer little more than the illusion of coverage.

This is what the next four years will look like if Trump is reelected. While there will almost certainly not be a repeat of the GOP’s disastrous attempt to repeal the ACA in Congress, the administration will use the regulatory authority it has to chip away at government coverage wherever it can, particularly by trying to restrict access to Medicaid, which covered nearly 67 million Americans as of earlier this year.

Those efforts appear to have already borne fruit; after plummeting as a result of the ACA, the number of Americans without health coverage has increased every year Trump has been in office. According to the latest Census Bureau data, nearly 30 million Americans were uninsured at some point in 2019. And that was before the pandemic hit and tens of millions of people lost their jobs.

The Trump administration simply does not see that as a problem that requires addressing. Quite the opposite; they want to push more people off their insurance. The administration official who oversees Medicaid, Seema Verma, has made no bones about her belief that every person who gets Medicaid represents a failure on the part of our society. When she isn’t spending millions of taxpayer dollars on Republican PR consultants to polish her public image, Verma devotes her efforts to finding new ways to reduce the number of Americans with secure health care.

If the Republican lawsuit to nullify the ACA were to succeed, it would take coverage away from about 20 million people in one fell swoop. But even if their suit fails, what we’ll see is a continued erosion of health security, combined with regular assurances from the president that his spectacular health plan is on its way, any day now.

And what if Biden wins? His Department of Health and Human Services would reverse the orientation of Trump’s, which would mean more stability and likely a slow increase in the number of Americans able to access government-provided insurance.

Meanwhile, Biden would attempt to get a reform bill into law. Among many other things, Biden would immediately cover all the low-income people in Republican states who were shut out of Medicaid when their states refused the ACA’s expansion of the program. He would allow Medicare to negotiate drug prices, which it is currently barred by law from doing.

And Biden would create a public insurance option, enabling just about anyone, even those who have employer-sponsored insurance, to get government-provided coverage if they want.

Trump attacks that as “socialized medicine,” even though he shows no indication of understanding either Biden’s plan or socialized medicine itself. (The two are quite different.) Nevertheless, Biden’s plan is more significant than many people realize. Because we went through a long period where it was framed as the “moderate” alternative to Medicare-for-all, the fact that it is far more sweeping than the ACA itself was somewhat obscured.

We have no idea what the final bill will look like if Biden is president, and how many of those provisions will survive the congressional meat grinder. But there will be a bill, and there will be an enormous fight over it.

The Biden campaign is rolling out a series of TV ads on health care, while on the other hand, I’d guess Trump hopes he gets no more questions about it between now and November. But with a pandemic still ravaging the country and the number of uninsured on the rise, it ought to be in the forefront of all our minds.

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