Fox News’ parent company board member Paul Ryan, who previously served as speaker of the House, made a bold prediction Tuesday: If President Donald Trump wins a second term, he will take on the issue of health care again — which would devastate people’s lives if it comes to fruition.

The potential impact of repealing the Affordable Care Act, as Republicans tried and failed to do in 2017, would mean tens of millions more people living without health insurance or paying increased premiums, and insurance companies would again be allowed to deny coverage due to preexisting conditions. Indeed, Ryan gave a presentation on the issue in 2017 in which he appeared to object to the whole principle of health insurance in the first place and spoke positively of switching over to an economy of individual price-shopping for important medical procedures.

As a result of these high stakes, health care was a major issue that drove Democratic victories in 2018. (And the Trump administration is still trying to get the whole ACA thrown out in court.)

Ryan made his prediction Tuesday in Abu Dhabi, United Arab Emirates, at the Middle East and Africa Summit hosted by the Milken Institute, an economic think tank founded by Michael Milken — who is both a noted philanthropist and one of the most notorious corporate criminals of the 1980s.

At the same time, the budget deficit and national debt are issues that Trump and Ryan themselves have only made much, much worse. Ryan had long maintained a reputation in Washington media as a deficit hawk, though his actual record by the time he left office ought to show just how wrong that perception really was.

Total federal debt issued in 2018, the last full year Ryan was House speaker, hit more than $1.3 trillion — the highest since the Great Recession, when Ryan had been a staunch critic of the Obama administration’s economic stimulus policies. Much of the growing deficit and debt can be attributed to the 2017 tax cut package that Ryan himself championed and still boasts of as an accomplishment (as he did during his discussion at the Milken Institute summit).

Ryan’s obvious answer to the debt problem that he made a whole lot worse is not to undo any of his tax cuts for the wealthy — but to “go after” health insurance instead.