As Republicans launched a last-ditch effort to repeal and replace the Affordable Care Act late last month, Mike Pence mounted a stage in his home state of Indiana and urged senators to support the proposal, called the Graham-Cassidy bill.
“A vote against Graham-Cassidy is a vote to save Obamacare,” Pence said to the crowd.
It didn’t work. By the next Friday, three senators gave three different reasons for why they couldn’t support the bill.
John McCain, R-Arizona, said he couldn’t support the bill because too much was still unknown about how much it would cost and who it would help or hurt. Susan Collins, R-Maine, said she didn’t think the bill was good for the people of her home state.
Only Rand Paul, Kentucky’s junior U.S. senator, refused to vote for the bill because it didn’t do enough to dismantle Barack Obama’s signature legislative achievement.
“I made a promise to repeal Obamacare, I went to rally after rally after rally,” Paul said at a Sept. 25 news conference. “I never had one person come up to me and say ‘oh what you mean by repeal is you’re going to keep most of the spending and you’re going to block grant it to the states.’ Nobody said that. This is not repeal, this is not what we promised.”
As Congress moves on to tax reform, putting a bookmark in the health care debate , Paul is left in a precarious political position.
He’s the man who saved Obamacare. For now.
‘I hereby pledge’
In 2010, when Paul made his outsider bid for Kentucky’s open Senate seat, he signed a pledge written by a conservative advocacy group called Club For Growth.
“I hereby pledge to the people of my district/state upon my election to the U.S. House of Representatives/U.S. Senate, to sponsor and support legislation to repeal any federal health care takeover passed in 2010, and replace it with real reforms that lower health care costs without growing government,” the pledge read.
To some Kentuckians, he hasn’t made good on that promise.
“He needs to get in gear and just do it,” said Cindy Marlow, a member of Kentucky’s Tea Party. “We need to get something and it would be nice to get full repeal, but we need something.”
Paul has railed against the Affordable Care Act as long as he has been in office. But as Republicans took complete control of Washington in January and started discussing health care legislation in March, he began stirring up trouble.
Deciding a House bill to repeal and replace Obamacare wasn’t conservative enough, he nicknamed it “Obamacare Lite,” wandered around the capital with a copy machine seeking to read the bill and called for the repeal and replacement of Obamacare to be handled separately — first repeal, then replacement.
After he helped vote down the Senate’s version of the replacement bill, Senate Majority Leader Mitch McConnell, Kentucky’s senior U.S. senator, granted Paul his wish and held a vote on Paul’s bill to repeal Obamacare without replacing it.
It failed 45-55.
By the end of that night, the Senate had taken multiple votes on repealing or replacing the Affordable Care Act. Rand Paul voted in favor of two of those attempts, none of which passed.
Refuse to compromise
As Rand Paul traveled around Kentucky promoting his idea to let people band together into health care associations in order to purchase insurance, Sen. Lindsey Graham, R-South Carolina, and Sen. Bill Cassidy, R-Louisiana, began trying to win over support for their own version of a bill to replace Obamacare.
The bill would shift the responsibility for Medicaid from the federal government to state governments, requiring states to create their own health insurance plans for the poor and disabled by 2020. It would also cap the amount of federal support states would receive per Medicaid enrollee, a provision the liberal-leaning Center on Budget and Policy Priorities said would have cost Kentucky about $3 billion a year by 2026.
Almost as soon as the bill came into the spotlight, Paul said he opposed it because it simply reshuffled much of the spending allowed under Obamacare.
“I cannot support a bill that keeps 90% of Obamacare in place,” Paul tweeted on Sept. 15. “#GrahamCassidy is not repeal or replace, it is more Obamacare Lite.”
Paul, who doesn’t face reelection until 2022, maintained his opposition to the bill even as President Donald Trump chastised him on Twitter and lawmakers attempted to allocate more money for Kentucky in the bill. Paul, who has often criticized former U.S. Sen. Henry Clay for compromising too much, once again refused to compromise.
“I voted for several compromises,” Paul said on Sept. 25. “The main reason I can’t vote for Graham-Cassidy is that I believe that it represents Republicans accepting a trillion dollars of Obamacare spending.”
Later that day, McCain said he wouldn’t support the bill and Collins said she likely wouldn’t vote for it. The bill was killed and the Sept. 30 deadline for approving the legislation passed, making it unlikely that Congress will consider another health care bill this year.
Collins and McCain were celebrated by advocacy groups supporting the Affordable Care Act.
Paul was not.
“His position is that it doesn’t go far enough in taking away health care from average Americans,” said Kentucky state Rep. Chris Harris, D-Forest Hills. “I don’t think there’s anyone on our side that wants to praise him for it.”
‘Cut our own throats’
While the Senate was debating Graham-Cassidy, Paul compared the effort to the advice given when someone has a kidney stone — pass it, pass it, pass it.
“After promising Kentuckians to repeal and replace Obamacare and offering his own plans to do so many times, Dr. Paul could not in good conscience support a bill that didn’t achieve that promise,” said Kelsey Cooper, a spokeswoman for Paul.
This stance, which prevented the elimination of something conservatives revile, leaves Paul facing criticism from some of his traditional supporters.
Marlow, the Kentucky Tea Party member, said she doesn’t admire Paul’s principled stance. She said her insurance costs increased because of the Affordable Care Act and she wants to see it end.
“It’s something where we can cut our own throats by not seeing the forest through the trees,” Marlow said. “Sometimes the things we want, we’re never going to get.”
Paul, though, was wary of Republicans being attached to a health care policy that didn’t fix the problems of the Affordable Care Act.
“I have a strong feeling that in 2018, everything is still going to be in disarray even if you pass this,” Paul said on Sept. 25. “And that disarray, who will be blamed for it? The people who now own the health care, which would be the Republicans. I think it’s actually better to continue to monitor the downward death spiral of Obamacare and see if it will finally give Republicans enough courage to do what they promised.”
In the meantime, Paul has secured his position as an ultra conservative on health care. What’s not clear is whether that stance will be an asset or a liability if he were to enter the 2020 Republican primary for president.
“I think the longterm political ramifications are good for him,” said Jesse Benton, a friend of Paul’s and former campaign adviser. “I think people want consistency. Long term, I think it just adds to Rand’s credibility that he’s always consistent over time.”