This week's failure of the Better Care Reconciliation Act, version 5.0 of the Republican health care plan, can best be understood by reviewing two famous statements Donald Trump made about health care policy.

Very early in his campaign for president, Trump promised that the Affordable Care Act would be repealed and replaced with "something terrific."

Eighteen months later, very early in his presidency, after actually learning something about health care policy, Trump said, "Nobody knew that health care could be so complicated."

In fact, anyone who's paid the slightest bit of attention to the system that accounts for one-sixth of the American economy knows health care is hideously complicated. The 2010 ACA was a rare attempt to make it work better for more Americans. Passing it was difficult, but the longer Americans had to get used to it, the more they liked it.

In a nutshell, that's why Senate Majority Leader Mitch McConnell, R-Ky. was unable to round up the votes he needed to move forward with the BCRA — even after finagling the rules so he only needed 50 votes. It was not the "something terrific" that Trump promised. It was something terrible.

The BCRA failed because Sen. John McCain, R-Ariz., needed time to recover from surgery last Friday to have a blood clot removed. McConnell needed McCain's vote, but in McCain's absence, pressure built on GOP senators who didn't like the bill. Sens. Mike Lee of Utah and Jerry Moran of Kansas announced Monday night they would join two other GOP senators in voting against it. Without them and McCain, McConnell had only 47 votes. He laid the bill aside.

Moran said he didn't like the way the bill would hurt rural hospitals and punish states, like Kansas, that didn't expand Medicaid. The bill would have hurt rural residents and hospitals in Missouri, which also didn't expand Medicaid. But Missouri Sen. Roy Blunt supported it. Go figure.

Trump immediately began advocating repealing the ACA effective in two years while Congress considered a better plan. A similar bill passed in 2015 but President Barack Obama vetoed it.

The Congressional Budget Office and the Joint Committee on Taxation later reported the 2015 bill would have cost 32 million Americans their insurance coverage by 2026 and raised premiums in the nongroup insurance market by 50 percent. The BCRA would have cost 22 million people their coverage and raised premiums by 25 percent, so repeal-and-replace-later is considerably worse.

Health insurance is complicated because every part of it affects every other part. The ACA began addressing that, and while it's not perfect, Americans got used to something better. Trump clearly doesn't understand the issue, and having seen him break one campaign promise after another, there's no reason to bet on "something terrific" down the road.

REPRINTED FROM THE ST LOUIS POST DISPATCH

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