In the presidential debate three weeks ago, GOP nominee Donald Trump made a breathtaking claim about his record on health care: He said that he had tried to “save” the Affordable Care Act when he was president.

During Tuesday night’s vice presidential debate, JD Vance repeated that claim and then took it one step further: that Trump had not only tried to save the health care law, but did so with help from Democrats.

“Donald Trump could have destroyed the program,” Vance said. “Instead, he worked in a bipartisan way to ensure that Americans had access to affordable care.”

This is pure fantasy, literally the opposite of the truth.

And it matters, because health care for tens of millions of Americans could depend on the election outcome. Voters have a right to know what Trump would do if he gets back to the White House, which means understanding what he actually did when he was there last.

The Obamacare Debate, As It Was

The real story goes like this:

Trump in his 2016 presidential campaign vowed to repeal the Affordable Care Act, also known as Obamacare. And it was not some incidental, throwaway line.

He mentioned it constantly, frequently at the beginning of his rallies. His campaign website said: “On day one of the Trump Administration, we will ask Congress to immediately deliver a full repeal of Obamacare.”

And Trump followed through on that promise. He spent most of his first year in office working with Republican leaders to pass repeal legislation.

But while Trump had repeatedly said he’d offer “great health care for much less money” and vowed that “we’re going to have insurance for everybody,” GOP legislation he backed would have dramatically reduced government spending on health care and weakened protections for people with pre-existing conditions.

Many millions were bound to lose coverage, as multiple independent projections showed.

Republicans knew these bills had little chance of winning Democratic support. Unlike former President Barack Obama and the Democrats in 2009 and 2010, who spent months trying (unsuccessfully) to negotiate with a handful of Republicans over what became the Affordable Care Act, GOP leaders like then-House Speaker Paul Ryan (R-Wis.) focused pretty much exclusively on consolidating support within their own party and pushing legislation through Congress as quickly as they could.

Republicans succeeded in getting their bills through the House but failed in the Senate, thanks to a handful of GOP lawmakers voting no.

In that sense, the only bipartisan action during the Affordable Care Act repeal debate was when Republican senators like Lisa Murkowski of Alaska and John McCain of Arizona ― in one of the final public acts of his life ― sided with Democrats and voted to stop Republican legislation from passing.

That defeat didn’t stop Trump, who spent the rest of his presidency looking for other ways to undermine or destroy the law. He cut funding for outreach and enrollment counselors, and had the federal government join a lawsuit asking the Supreme Court to declare the entire program unconstitutional.

Not all of these efforts had much effect and one actually backfired, prompting an insurance industry reaction that made Obamacare’s financial aid more generous. But Trump’s intent was clear: to “repeal and replace the disastrous Obamacare law,” as an official White House statement put it at the time.

And Trump is still talking about that now. Last November, he posted on Truth Social that he was still “seriously looking at alternatives.” And after acknowledging that “a couple of Republicans senators” stymied his 2017 effort failures, he said Republicans “should never give up!”

Last month, in the debate with Democratic presidential nominee Kamala Harris, Trump said he still wanted to replace the law and that he had “concepts of a plan” for doing so ― although, as usual, he didn’t specify what those concepts were.

The Obamacare Debate, As It Is

Conservatives have plenty of serious, intellectually consistent reasons to oppose the Affordable Care Act.

The law dramatically expanded Medicaid, an already-substantial government program that provides health care for the poor. It also introduced a new set of subsidies to help people buy health insurance.

These two steps required a lot of new government spending, estimated at roughly a trillion dollars in the first ten years alone. The law financed these expenditures mainly by reducing Medicare payments to hospitals and other suppliers of health care, and imposing new taxes on the wealthiest Americans.

The Affordable Care Act also imposed new rules on private insurance, by requiring carriers to sell more comprehensive policies and prohibiting them from denying coverage to people with pre-existing conditions.

New government spending, new regulations, new taxes ― Republicans oppose all of these things, arguing they make Americans’ lives worse rather than better.

And when Trump first ran for office, his calls for repealing the ACA probably won him votes. Plenty of people were still struggling with health care costs, including some people whose insurance premiums had increased because of the law’s changes.

But public opinion turned sharply against repealing the ACA once people realized it’d mean giving up some of the law’s protections for people with pre-existing conditions, not to mention the prospect of so many people losing insurance altogether. Whatever their disappointments and frustrations, voters didn’t want to go back to the way things were before.

And anger over repeal didn’t go away when the legislation died. The backlash was a major reason Republicans lost control of the House in 2018 and then gave up the Senate and White House in 2020.

Today’s Republicans know that, which is why most of them have tried to avoid the subject of health care altogether ― and, if it comes up, now insist they don’t want to take away what Obamacare has provided.

But there are all kinds of signs Republicans remain interested in repealing the Affordable Care Act, or at least rolling back parts of it. Those signs include references in conservative agenda documents like Project 2025, as well as statements Vance made during an interview on NBC’s “Meet the Press.”

Vance’s comments were especially telling because he said Republicans were interested in a “deregulatory agenda” in order to avoid a “one-size-fits-all approach that puts a lot of people into the same insurance pools.”

That’s the way Republicans described their plans to loosen the Affordable Care Act’s rules back during the repeal debate ― an episode that Vance on Tuesday night did his best to make the public forget.