ACTING WHITE HOUSE Chief of Staff Mick Mulvaney insisted Sunday that the 60 million Americans with preexisting medical conditions have no reason to fear President Trump’s new push to scrap Obamacare. “The debate about preexisting conditions is over,” he said. “Both parties support them, and anyone telling you anything different is lying to you for political gain.”

He’s right that someone is being dishonest about preexisting conditions, but it’s not the Democrats. For nine years, Republicans have promised a silver-bullet policy that would adequately cover Americans without resort to big spending, mandates or costs to healthy people, if only the voters would let them govern. After voters put them in charge, they offered one half-baked plan after another and never could pass one. Mr. Mulvaney is either deluded or himself lying when he argues that Republicans have a respectable record on preexisting conditions.

Trump senior adviser Kellyanne Conway complained Sunday that it is unfair to expect the president to have a health plan after a mere two years in office. Now the White House is apparently working on one. News reports indicate that it will be based on a proposal that Sens. Lindsey O. Graham (R-S.C.) and Bill Cassidy (R-La.) introduced toward the end of the Republicans’ abortive 2017 repeal-and-replace push. The plan was perhaps the most sweeping that Republicans seriously considered, and just like other major GOP proposals considered in 2017, it would have undercut protections for people with preexisting conditions.

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The underlying problem with Republicans’ health-care positioning is that there are only so many ways to cover people with expensive medical conditions, and all of them cost someone money. Either the government must foot an astonishingly large bill for sick people’s care, an idea from which Republicans recoil, or costs must be spread widely among a diverse group of people in an insurance pool, which was the Obamacare model that Republicans rejected furiously. Because they are committed to dismantling Obamacare but unwilling to spend lots more federal money, their Obamacare replacement plans have been invariably harder on sick and low-income people than the existing system.

The Obamacare repeal-and-replace debate did underscore the extent to which there is a national consensus that the government must ensure that vulnerable Americans have access to decent health-care coverage. Republicans therefore regularly insist that they believe in protecting people with preexisting conditions. They just cannot agree on a plan that would adequately do so.

Mr. Trump said last week that “the Republican Party will soon be known as the party of health care,” and he has encouraged several GOP senators to start working on the issue, signaling that he intends to talk health policy during the 2020 presidential race. Voters should not settle for fantasies, false promises and wishful thinking.

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