As we get closer to the eventual unveiling of the GOP’s “big, beautiful” budget-reconciliation bill, which will advance most of Donald Trump’s 2025 legislative agenda, the 47th president is clearly experiencing some bad memories from 2017. As you may recall, his first budget-reconciliation bill back then was marketed as legislation to “repeal and replace Obamacare,” in deference to that great obsession of the tea-party predecessors to the MAGA movement.

That legislation failed, doomed as it was by Senate Republican defections (most famously by the late John McCain, who gave one version of “Trumpcare” a decisive thumbs-down). And worse yet, the whole extended saga reinforced the GOP’s reputation as a band of reactionaries determined to take away health insurance from people without ever showing any capacity for finding alternatives to the federal programs they deplored. Trump’s own decade-long failure to redeem his promise to offer a health-insurance proposal that’s better than Obamacare became a regular punch line during his first term.

According to one House Republican leader, the 47th president is worried it could all happen again:

House Ways and Means Chair Jason Smith (R-Mo.) said Sunday that President Trump “does not want” the “one big, beautiful bill” encompassing his agenda “to be a health care bill ….”

“[T]he president’s been crystal clear … that he will not be cutting [Medicaid] benefits for individuals, will not allow that,” he added. “He does not want this to be a health care bill. This is an economic bill that secures the border and unleashes U.S. energy.”

Unfortunately for GOP branding needs, the arithmetic and politics of the “big, beautiful bill” mean they absolutely are going to cut Medicaid benefits for individuals — though they will claim they’re just going after “waste, fraud, and abuse” and/or “giving” the states more responsibility for the joint federal-state program (by giving them less federal money, of course). Trump himself promised to leave Medicaid alone in 2016 before the Obamacare repeal-and-replace bill he endorsed went after Medicaid benefits. But he didn’t fool anyone in 2017 and may not fool anyone this time either.

One 2017 tactic Trump has already decided not to reprise is the two-reconciliation-bill strategy spearheaded by then–House Speaker Paul Ryan and Senate Majority Leader Mitch McConnell. Even after disaster struck the Obamacare bill, Republicans were able to make a late-year comeback by passing a second reconciliation bill focused on tax cuts (the very same tax cuts that are for the most part expiring at the end of 2025, requiring their renewal). Senate Republicans strongly preferred a two-bill strategy for 2025, giving Trump an early “win” on border security, defense, and energy spending before coming back later with a much bigger bill that cut taxes and spending. But Trump insisted on one all-or-nothing bill on grounds that it might be very difficult to get more than one such measure through the closely divided House.

This approach may halve the opportunities for everything to go off the rails in 2025. But it also exposes the entire package to Democratic claims that it is designed to cut Medicaid benefits in order to give Trump’s billionaire buddies more tax cuts — hence Trump’s strong interest in distracting attention from the health-care elements of the bill. He’s probably also hoping to make it until the end of his presidency without ever having to develop or embrace his own health-insurance proposal beyond the “concepts of a plan” he briefly mentioned during the 2024 campaign.

Two things we know for sure are that anything Republicans try to do on health insurance will be bad for health-care coverage, and that the entire issue is a perpetual loser for the GOP. Team Trump doesn’t seem overly worried by the administration’s identification with Robert F. Kennedy Jr.’s MAGA agenda of conspiracy theorizing and demands that Americans just take better care of themselves. But anything beyond that will be unhealthy for Trump and his party.

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