Donald Trump has absolutely no idea what's going to replace the Affordable Care Act

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Donald Trump sat down for the first interview of his presidency on Wednesday with ABC News' David Muir. The whole thing was a familiar retread of the new president's darkest instincts.


He falsely alleged that massive voter fraud robbed him of the popular vote, a lie that has been debunked as many times as it's been uttered but will still be the pretext his administration and Republicans use to purge voter rolls and enact restrictive voter laws that disenfranchise voters of color and others.

Trump showed Muir a picture of his inaugural crowds and talked about having the nuclear codes. He reasserted, without really seeming to understand what he was saying, that he would "send in what we have to send in" to Chicago, which he called a "war zone" and "worse than some of the people that you report in some of the places that you report about every night in the Middle East." He talked about his administration's Muslim ban, which he told Muir he would be "thrilled" about.

He also spent three minutes ad libbing on his plans to repeal the Affordable Care Act, a law that, once lost to the vindictive incompetence of this administration and this Congress, will kill 43,000 people annually, according to an analysis from the New England Journal of Medicine.

It was a string of sentences so incoherent and so wildly contradictory that it's worth sharing them in full (emphasis mine):

It's going to be—what my plan is is that I wanna take care of everybody. I'm not gonna leave the lower 20% that can't afford insurance. Just so you understand people talk about Obamacare. And I told the Republicans this, the best thing we could do is nothing for two years, let it explode. And then we'll go in and we'll do a new plan and—and the Democrats will vote for it. Believe me.

Because this year you'll have 150% increases. Last year in Arizona 116% increase, Minnesota 60 some-odd % increase. And I told them, except for one problem, I wanna get it fixed. The best thing I could do as the leader of this country—but as wanting to get something approved with support of the Democrats, if I didn't do anything for two years they'd be begging me to do something. But I don't wanna do that. So just so you understand—Obamacare is a disaster.

It's too expensive. It's horrible health care. It doesn't cover what you have to cover. It's a disaster. You know it and I know it. And I said to the Republican folks—and they're terrific folks, Mitch and Paul Ryan, I said, 'Look, if you go fast—and I'm okay in doing it because it's the right thing to do. We wanna get good coverage at much less cost.' I said, 'If you go fast we then own Obamacare. They're gonna put it on us. And Obamacare is a disaster waiting to explode. If you sit back and let it explode it's gonna be much easier.' That's the thing to do. But the right thing to do is to get something done now.


The best thing to do. The right thing to do. The thing to do. Get something done. If I didn't do anything. I don't wanna do that.

Last Friday, while interviewing people at the inauguration, I met a man in a Bikers for Christ leather jacket who had ridden all the way from Tennessee to Washington, DC to see Trump sworn in. He talked to me about health care, about how veterans couldn't get it and how the system was expensive and broken. I asked him if he was worried that 20 million people could lose insurance if the law is repealed without an adequate replacement.


He told me: "I don’t think they’re gonna lose it. I think Trump has already got in place a plan, to be honest with you."

This man was earnest, I believe he believed that, but he was wrong. Donald Trump does not have a plan to replace the Affordable Care Act.


And the inadequacies of whatever Republican alternatives are currently banging around—plans that may cost very little because they provide virtually no coverage, high risk pools that cluster sick people together and saddle them with premiums that are sometimes 250% above market averages, block granting Medicaid so that fewer people get less comprehensive coverage—will leave people vulnerable to crushing medical debt, preventable illness, and even death.

Instead of asking about these things, David Muir asked the president to reassure people that they wouldn't lose coverage.


"You know, when you say no one I think no one. Ideally, in the real world, you’re talking about millions of people. Will no one?" Trump replied. "And then, you know, knowing ABC, you'll have this one person on television saying how they were hurt. OK. We want no one. We want the answer to be no one."

Do you feel reassured?