Republicans have told many lies about health care over the years.

JD Vance on Sunday doubled down on their newest one.

During an appearance on NBC’s “Meet the Press,” Vance claimed that Donald Trump during his presidency “protected” Americans getting insurance through the Affordable Care Act “from losing their health coverage.”

Vance, a Republican senator from Ohio who is now his party’s vice presidential nominee, went on to say that Trump “actually protected a lot more additional Americans from losing their health coverage.”

Trump had said something similar during Tuesday’s presidential debate, when he claimed he “saved” the 2010 health care law during the presidency.

In reality, Trump spent the first year of his presidency trying to repeal the Affordable Care Act, following through on a promise he’d made from the very first days of his 2016 presidential campaign.

The law, also known as “Obamacare,” allowed many millions of Americans to get insurance by enrolling in Medicaid or subsidized private insurance ― and by prohibiting insurers from denying coverage to people with preexisting conditions.

It’s the reason the number of Americans without insurance has plummeted to record lows.

As a candidate and then as president, Trump repeatedly assured Americans that he would replace the Affordable Care Act with “something terrific” ― that, “it’ll be great health care for much less money” and that “we’re going to have insurance for everybody.”

But Trump never had such a plan.

Instead, once he became president, he pushed Congress to pass Republican bills that would have undermined those new rules on insurers, while dramatically reducing funding and eligibility for the new insurance offerings.

As a result, according to multiple independent projections, many millions would have lost insurance.

An Example Of Trump’s Intentions On Health Care

One such piece of legislation was the “American Health Care Act of 2017,” whose passage through the House of Representatives Trump celebrated with a rally on the White House lawn.

Had that proposal become law, the Congressional Budget Office predicted, the number of Americans without insurance would have soared ― by 19 million as of 2020, and by 23 million as of 2026.

That House bill ― and, really, any of the several repeal bills that Trump backed in 2017 ― would have realized longtime conservative goals, like reducing regulation of the private sector and federal spending.

Some Americans buying insurance on their own would have been able to find cheaper insurance, Trump and his allies noted, primarily because insurers would no longer have to comply with the Affordable Care Act’s rules.

Many insurers had canceled old plans in response to the new rules, despite promises by then-President Barack Obama that people who liked their existing insurance could keep those policies.

But the Affordable Care Act’s rules are what made insurance more comprehensive and more available to people with preexisting conditions.

Without those same rules in place, CBO predicted, some Americans “with preexisting or newly acquired medical conditions” would “ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all.”

The prospect of so many people losing insurance ― and those rules on pre-existing conditions going away ― proved to be highly unpopular. It also alarmed a handful of Republican lawmakers, like Sen. Lisa Murkowski of Alaska, who voted against repeal in the Senate, stopping it from becoming law.

The backlash fueled a broader political rebuke to Republicans, allowing Democrats to retake control of Congress and the White House.

That political backlash is why Republicans nowadays rarely talk about repealing the Affordable Care Act ― and, if they do, they promise (as Trump still does) they have a better plan.

Why Obamacare Is A 2024 Campaign Issue

Trump’s intentions and record on the Affordable Care Act matter because of multiple signs the law’s future depends on what happens in the 2024 presidential election ― and, more specifically, on whether Trump wins and Republicans get control of Congress.

Two prominent conservative manifestos, the Heritage Foundation’s Project 2025 and the House Republican Study Committee’s latest budget proposal, call for rolling back big pieces of the law.

Last fall, Trump posted on Truth Social that the Affordable Care Act “sucks” and that Republicans should “never give up” on trying to “terminate” it. During Tuesday’s debate, Trump said he remained interested in replacing the law, promising that he had “concepts of a plan” that would offer Americans a better deal.

As usual, Trump offered no more details on what that might mean. But Vance on “Meet the Press” offered a hint when he said, “We want to make sure everybody is covered, but the best way to do that is to actually promote some more choice in our healthcare system and not have a one-size-fits-all approach that puts a lot of people into the same insurance pools, into the same risk pool.”

That’s the same argument Republicans used to justify their proposals during the 2017 repeal fight ― that, by loosening rules on health insurance, insurers could market less generous plans or restrict enrollment based on health status, so that cheaper policies were available to some.

The tradeoff, as that CBO report noted, would have been higher prices, inadequate benefits or no coverage at all for people with more serious medical conditions.

If the last debate is indicative, that’s not a tradeoff the public wants to make.

Of course, plenty of Americans still struggle with health care costs. Even the Affordable Care Act’s biggest champions acknowledge that it’s a complex, flawed program that still has big gaps. But polls have shown consistently that a solid majority of Americans approve of the law.

Vice President and 2024 Democratic presidential nominee Kamala Harris has pledged to bolster the law ― among other things, by renewing extra financial assistance that President Joe Biden and the Democrats put in place.

Those extra subsidies, which have lowered insurance premiums for millions, are set to expire after 2025. Renewing them would be expensive: Extending the assistance for a full decade would require more than $300 billion in new federal spending, according to CBO.

That money would have to come from somewhere — either new taxes, spending cuts elsewhere or money added to federal deficits.

Trump has not indicated whether he too supports extending the assistance. But given how he and Republicans feel about the Affordable Care Act ― and government involvement in health care more generally ― it’s hard to imagine either wants the boost to remain in place.