The Trump administration will no longer defend the preexisting conditions coverage requirements of the Affordable Care Act. That's an enormous shift from where Donald J. Trump has been in the past.
The Trump administration will no longer defend the preexisting conditions coverage requirements of the Affordable Care Act. That's an enormous shift from where Donald J. Trump has been in the past. (Thomas Northcut / Getty Images)

With all the attention given the Donald J. Trump-Kim Jong-un summit this week and the president’s pie-in-the-sky, ridiculously false claim on Twitter that “There is no longer a Nuclear Threat from North Korea,” it would be easy to overlook Mr. Trump’s sudden rewrite on health care. In a carefully worded letter, Attorney General Jeff Sessions revealed that the administration “with the approval of the President of the United States” no longer supports a provision of the Affordable Care Act that requires insurance companies to cover applicants regardless of whether they have a preexisting health condition.

The reversal comes in the context of a Republican-led lawsuit (Texas v. United States) in which the federal government has been defending the constitutionality of the ACA. It means the Justice Department, and President Trump, are essentially choosing to side with the plaintiffs and abandoning a position that Mr. Trump has been touting since the early months of his candidacy. Whatever the legal arguments, the facts of the ACA haven’t changed, only Mr. Trump’s interpretation of that reality has.

Enrollment at the state's health insurance exchange is up in 2018, despite Republican efforts to repeal the Affordable Care Act.

Remember the Republican presidential primary debates of 2016? Voters should. The GOP candidates were scrambling to one-up themselves over how much they hated Obamacare and how quickly they’d put the health care reform law that expanded health insurance to millions of Americans six feet underground once they landed in the Oval Office. Mr. Trump had a slightly different take. Oh, he hated the ACA alright but he sure liked that preexisting conditions were covered. “I would absolutely get rid of Obamacare. We’re going to have something much better, but preexisting conditions, when I’m referring to that, and I was referring to that very strongly on the show with Anderson Cooper [of CNN], I want to keep preexisting conditions. I think we need it. I think it’s a modern age. And I think we have to have it,” Mr. Trump said at the CNN-Telemundo debate in Houston in late February of that year.

An aberration? Hardly. Mr. Trump said something similar one week earlier during an interview with Mr. Cooper as well as during a debate with Hillary Clinton, the Democratic nominee, in early October eight months later, advocating for “getting rid of those lines (meaning interstate competition among insurers) and “keep preexisting” to help the poor because “we are going to have people protected,” he said in the second presidential debate held at Washington University in St. Louis. And the list goes on and on well into his presidency whether in rallies or interviews or on Twitter (“I would not sign Graham-Cassidy [a Senate ACA repeal bill] if it did not include coverage of pre-existing conditions,” he tweeted on Sept. 20, 2017.

Now, perhaps the president has simply had a change of heart and wasn’t lying all those times he said he would support coverage of preexisting conditions — a provision that consistently polls well with Americans — but that explanation doesn’t show up anywhere in Mr. Sessions’ letter. Naturally, Democrats in Congress are salivating at the prospect that the GOP is going all-in with their disdain for health insurance coverage provided by the ACA. Without the preexisting conditions requirement, millions of Americans are going to find themselves back on the outside of decent medical care looking in. “If Republicans are serious about maintaining protections for people with pre-existing conditions, they should join us in urging the Trump administration to reverse their shameful decision to not defend the constitutionality of that vital provision that is already the law,” Senate Minority Leader Chuck Schumer tweeted on Tuesday.

But what truly elevates Mr. Trump’s reversal on this to Alternative Fact of the Week proportions is that, whether as a candidate or president, Mr. Trump has been merciless in his criticism of Barack Obama for suggesting that the ACA would ensure Americans could keep their health care providers. And while it’s true the ACA didn’t require Americans to change their doctors (and most didn’t), it generated such an upheaval in the individual market, that many people had to change coverage and as a result, change providers. President Obama was seen as someone who makes stuff up. Will political conservatives be far more forgiving of Mr. Trump’s misrepresentations of the past? You better believe it. If they can tolerate his claims of a nuclear-threat-free North Korea, despite the absence of any real progress beyond a handshake in Singapore, anything is possible.