Trump and House Republicans gather in the Rose Garden after the passage of an Obamacare-repeal bill in May 2017.Carlos Barria / Reuters

In one of many tweets last week, President Donald Trump declared: “All Republicans support people with pre-existing conditions, and if they don’t, they will after I speak to them. I am in total support.” His statement probably puzzled Americans who remember what happened in May 2017, when Trump and House Republicans met in the Rose Garden to celebrate their votes to repeal Obamacare—which guarantees health coverage to people with preexisting conditions.

Trump’s tweet seems out of sync, too, with what happened earlier this week when his Department of Health and Human Services released new rules that will likely make it tougher for people with serious medical conditions to buy affordable coverage.

Obamacare is still the law of the land after the Senate blocked the last GOP repeal bid, but the department will allow states to circumvent some key requirements. The fine print is complicated, but, in essence, states will be able to offer cheaper plans with fewer consumer protections via waivers granted by HHS. Healthy people would likely buy those plans and leave Obamacare with a smaller, sicker pool of patients. A smaller pool means higher premiums. As Sabrina Corlette, a health-research professor at Georgetown University, points out, the department’s move means that “comprehensive coverage will be more expensive for those who need it most.”

Yet Trump and Republican congressional candidates across the country continue to insist that they are committed to providing sick people with accessible health insurance. In this election season—with health care topping the list of voter concerns and with Democrats holding a clear polling advantage on the issue—Republicans have become masters of the mixed message.

Tom MacArthur, an incumbent House Republican in a tough reelection race in New Jersey, says that protecting people with preexisting health woes “is a pretty essential pact with the American people”—despite the fact that he played a major role in the 2017 Obamacare-repeal effort, pushing a provision that would have raised rates and imperiled coverage for many with preexisting conditions.

Scott Walker, the Wisconsin governor waging his own tough race, says that protecting those people is imperative—even though his state attorney general has joined a federal lawsuit with 19 other Republican attorneys general that seeks to have Obamacare ruled unconstitutional. Josh Hawley, the Republican Senate candidate in Missouri, says he’s a champion of sick people—though, in his current job as state attorney general, he, too, has joined that suit.

Then there was the testy exchange earlier this week between Martha McSally, the Republican Senate candidate in Arizona, and Fox News Sunday host Chris Wallace. “I am passionate about protecting people with preexisting conditions and forcing insurance companies to provide them health insurance,” McSally said. “I voted to make sure that they had that coverage.” But Wallace pointed out that McSally, as a House member, voted last year to repeal Obamacare. Wallace said:

Congresswoman, let me just jump in here. Because under repeal-and-replace, the bill that you voted for, if someone had a lapse in coverage of 63 days—and, of course, a lot of these are cases of preexisting condition, are people who don’t have insurance and then want to buy it—if you had a lapse in coverage for 63 days, states could force those people, instead of buying it from an insurance company, to buy it from a risk pool. And that meant that the premiums would be higher. That’s exactly the kind of thing that Obamacare tried to prevent.

In response, McSally ignored Wallace’s accurate description: “This is just a lie we’re seeing all over the country, playing on people’s fears. But I want the voters to know I’m committed to protecting people with preexisting conditions. I’m fighting for it. I fought for it. And I voted for it.”

To understand why Trump and the Republicans have been struggling to craft a consistent health-care message, and why in some cases they’re airbrushing their past opposition to health reform, one need only look at the polls. They’ve found themselves on the wrong side of the issue in terms of public opinion: Thanks in part to their relentless attempts to repeal Obamacare, a mission that long predated Trump’s ascent, the law is now more popular than ever. According to a Fox News poll released last weekend, 53 percent of Americans—and 54 percent of likely midterm voters—endorse former President Barack Obama’s signature domestic achievement. Most notably in the Fox poll, Obamacare is 10 points more popular than Trump.

Meanwhile, according to the Kaiser Family Foundation’s September tracking poll, three in four independents, and even 58 percent of Republicans, said it was “very important” for insurance companies to guarantee coverage to people with preexisting conditions. Seventy-one percent of independents and 56 percent of Republicans said it was “very important” that sick people not be hit with higher premiums than other customers. With respect to the lawsuit from Republican attorneys general, the Kaiser poll says, “Three-fourths of the public say it is ‘very important’ to them that the provision that prohibits health insurance companies from denying coverage because of a person’s medical history remains law.” Kaiser reports that roughly 52 million Americans under age 65 have preexisting health conditions—and that health care ranks No. 1 as the most important issue for midterm voters.

All of which explains why Democratic candidates and allied groups have been flooding the zone with health-care ads—nearly 56,000 from January to July, according to trackers at the Wesleyan Media Project. From September 18 to October 15, in House and Senate races, almost 55 percent of all Democratic ads featured health care.

It’s a stark reversal of fortune: It was only eight years ago, in the 2010 midterms, that Republican candidates were hammering 24/7 about the alleged evils of the newly enacted Obamacare, and Democratic incumbents on Capitol Hill were either fleeing the issue or taking abuse at tempestuous town halls.

Now it’s the GOP playing defense on health care. And Trump’s sporadic attempts to give the Republicans some cover—at an early October rally he proclaimed, “Preexisting conditions are safe, okay? Just remember that”—have been undercut by Senate Majority Leader Mitch McConnell’s recent remark that if Republicans retain control of the upper chamber, they might take another run at repealing Obamacare. Trump, at least, seems attuned to the American majority’s mood; he also told rally-goers that he would “always fight for and always protect patients with preexisting conditions.” McConnell is not.

In what may be a last-ditch attempt to change the health-care narrative, Trump and Republican candidates have focused on the enthusiasm, in some Democratic circles, for a national health-care program that’s loosely described as Medicare for All. Politically, the GOP views it as an opportunity to paint its proponents as “socialists” and to compel all Democratic candidates to either endorse or disavow the idea. Trump attacked it recently in a guest column for USA Today that required extensive fact-checking from the press.

But that Republican strategy also appears to be problematic. Recent polls have shown that a substantial majority of Americans—70 percent—support the concept of Medicare for All. Nobody knows how a national plan would work in practice: Single payer? Public option? A major compromise, such as lowering the Medicare-eligibility age? But for now, Republicans appear to be betting against a broadly popular aspiration.

The president famously lamented last year that “nobody knew that health care could be so complicated.” Trump was referring at the time to the GOP’s frustrations with policy. But in this election season, given the party’s mixed messages and struggles on the trail, he could surely say that about the politics, too.

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