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The biggest lie in Trump’s State of the Union speech

Trump wants people who depend on Obamacare to relax. They do so at great peril.

Carrying photographs of Americans with preexisting medical conditions, Senate Minority Leader Chuck Schumer and Speaker of the House Nancy Pelosi lead a group of Democratic members of Congress to a press conference in Washington, DC, on July 9, 2019.
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Ian Millhiser is a senior correspondent at Vox, where he focuses on the Supreme Court, the Constitution, and the decline of liberal democracy in the United States. He received a JD from Duke University and is the author of two books on the Supreme Court.

If you have an expensive health condition, and you don’t know much about President Trump’s record on health care, then his Tuesday night State of the Union address was reassuring.

“I have also made an ironclad pledge to American families,” Trump claimed. “We will always protect patients with preexisting conditions.”

The bad news for people with preexisting conditions is that this “ironclad pledge” is a lie. Trump and his administration have fought hard — in all three branches of government — to strip people with preexisting health conditions of the protections they enjoy under the Affordable Care Act. Indeed, if Trump has his way, those protections will cease to exist.

Obamacare provides that insurers in the individual health insurance market must cover people with preexisting conditions, and it forbids those insurers from charging higher premiums to people with such conditions — a practice known as “community rating.”

The executive branch cannot, acting on its own, eliminate community rating altogether. But the Trump administration has fought hard to undermine it. In 2018, for example, it handed down a rule expanding the use of short term insurance plans to that do not cover many services, and that may exclude people with preexisting conditions.

The mere existence of these plans can drive up premiums for people with expensive preexisting conditions, because these skimpy plans will lure healthy consumers away from more generous plans. That risks creating a segregated market. Healthy consumers will buy cheap, watered-down plans, while people with expensive medical conditions will be concentrated into much more expensive plans.

In Congress, meanwhile, Trump supported legislation seeking to repeal Obamacare or drastically water down its protections. One bill backed by Trump, the American Health Care Act, would have allowed many insurers to charge higher premiums — potentially prohibitively high premiums — to patients with preexisting conditions.

Meanwhile, the Trump administration is currently asking the courts to repeal Obamacare almost in its entirety. If the courts ultimately embrace the administration’s position, that will mean that all of Obamacare’s protections for people with preexisting conditions will be struck down.

Trump, it’s worth noting, has a history of claiming that he will protect Americans’ access to health care, then pushing policies that would strip health coverage from millions of Americans. He claimed in 2015, for example, to be the “first & only potential GOP candidate to state there will be no cuts to Social Security, Medicare & Medicaid,” but his 2020 budget proposal would cut Medicaid spending by $1.5 trillion over the next decade.

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