In an interview with Time in May, Donald Trump acknowledged that understanding health-care policy “wasn’t high on my list” when he ran his own company. Several weeks earlier, he had complained that “nobody knew that health care could be so complicated.” But having received a crash course, he claimed, he was up to speed on the subject. “In a short amount of time I understood everything there was to know about health care.”

With the Republican plan to repeal Obamacare collapsing, once again, amid stark disagreements between conservatives and centrist Republicans over a replacement plan, however, Trump seems as confused as ever. Even more concerning, it is increasingly obvious that the president does not understand what insurance is at a fundamental level. When asked about health care during an interview with The New York Times on Wednesday, this is how he responded:

So pre-existing conditions are a tough deal. Because you are basically saying from the moment the insurance, you’re 21 years old, you start working and you’re paying $12 a year for insurance, and by the time you’re 70, you get a nice plan. Here’s something where you walk up and say, “I want my insurance.” It’s a very tough deal, but it is something that we’re doing a good job of.

“I know a lot about health care,” Trump declared later on in the interview. It is clear, though, that he does not. A $12 annual health-insurance premium is, of course, a laughable concept, and most health-insurance premiums are paid on a monthly, not yearly, basis. In 2016, a single person paid an average annual premium of $6,435, with employees picking up 18 percent of the cost, according to the Henry J. Kaiser Family Foundation and the Health Research and Educational Trust. Under the Affordable Care Act, the national average cost for a 21-year-old with the lowest-level insurance premium is about $153 per month.

Trump’s comments on Wednesday do not mark the first time he has radically misstated the average costs associated with health care. He provided a similar quote to The Economist in May, in which he said health care should cost about $15 per person per month. “Insurance is, you’re 20 years old, you just graduated from college, and you start paying $15 a month for the rest of your life and by the time you’re 70, and you really need it, you’re still paying the same amount and that’s really insurance,” he said. Later on, he apparently doubled down, adding: “We’re going to have much lower premiums and we’re going to have much lower deductibles.” (Estimates by the Congressional Budget Office suggest that both the House and Senate bills to repeal and replace Obamacare would increase premiums and deductibles for older people and people with pre-existing conditions, though health care could become more affordable for younger, healthier people.)

The president of the United States seems unaware that health-care premiums can cost even young individuals without health issues hundreds of dollars every month. His suggestion that you “get a nice plan” when you turn 70 also suggests that he may be thinking of a whole life-insurance policy, where beneficiaries can withdraw cash or take out a loan against the money they’ve paid into the plan. Life insurance has much lower premiums than health insurance. It is also an entirely different benefit program that has nothing to do with covering medical costs, though life-insurance companies do advertise frequently on the cable-news channels Trump spends his mornings and evenings watching, so one can see how he might be confused.