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Sen. Rand Paul Says He Won't Vote For Latest Affordable Care Act Replacement Bill


Republicans have until September 30 to pass their latest bill aimed at overhauling the Affordable Care Act, or Obamacare. House Speaker Paul Ryan says this is the best last chance to get repeal and replace done. With no Democrats onboard, if three Republican senators vote against the bill, it will fail. Senator Rand Paul of Kentucky has said that he is a no vote, and he joins us now. Welcome to the program.

RAND PAUL: Thanks for having me.

SHAPIRO: Today President Trump tweeted, Rand Paul is a friend of mine, but he is such a negative force when it comes to fixing health care. Graham-Cassidy bill is great - ends Ocare. Of course Graham-Cassidy is the current bill. So by voting against this, are you simply leaving the Affordable Care Act in place, which in your view is even worse than the current bill?

PAUL: You know, as a physician, I've seen Obamacare up close, and I don't think it's been good for the country. Premiums in the individual market have doubled. People are unhappy with the cost of insurance. There's many counties around the country where nobody has any insurance. So no, I'm absolutely opposed to Obamacare, and I promise to repeal it. I've introduced repeals but have also introduced replacement bills.

The problem I have with this current bill is it basically keeps the Obamacare spending, keeps the Obamacare taxes - most of them - and then actually just redistributes the money from Democrat states to Republican states. So I don't think this really fixes a problem, nor does it honor our pledge to repeal Obamacare, so...

SHAPIRO: But by voting against it, are you in effect letting the perfect be the enemy of the good?

PAUL: You could maybe say I'm letting perfect be the enemy of a really crappy bill. I mean this bill isn't anywhere near perfect. It's not even anywhere near good. Look at it this way. Usually appropriation bills labor through a process very public with public scrutiny and appropriation committees. This is not going to any committee, and it's a trillion-dollar appropriation.

SHAPIRO: I'm sure you've had conversations with Senator Graham and Senator Cassidy, the sponsors of this bill. Are there any changes they could make that would get you to flip your vote?

PAUL: Well, the thing is - is that I'm not for Obamacare. They basically immortalize Obamacare. They just do a little bit less spending than is in the current form of Obamacare, and they redistribute the proceeds of Obamacare spending to Republican states.

SHAPIRO: So nothing they could change that would flip your vote.

PAUL: Well, it's a really bad (laughter) idea. The whole thing has nothing to do with repeal. It has to do with keeping Obamacare and simply messing with the Democrats by taking the money from Democrat states and giving it to Republican states. But it keeps in place most of...

SHAPIRO: OK. I'm going I take that to mean your vote is set in stone (laughter).

PAUL: Well, the thing is - is there are other possibilities. What I would say is that there is one part of the insurance market that currently works pretty well. It's called large group ERISA plans that have self-insured component to it. So if you look at their premiums - this is about a third of the marketplace - their premiums are fairly flat. Insurance are not rising. So the group market actually works.

What I'm advocating is that individuals - if you're a plumber, a carpenter, a doctor with a small office, a lawyer - somebody who has a small business, let them join associations across state lines to get leverage for buying power. And actually, this has a great deal of appeal across party lines. And there actually can be done by executive action and executive interpretation - I think they're going to be within the next week or two.

SHAPIRO: But do the associations have the same protections as insurance companies, where there are basic requirements for coverage for financial resources?

PAUL: Yes.

SHAPIRO: My understanding from the health experts we've spoken to is that they don't.

PAUL: Well, you're wrong. And so if you look at group coverage, you'll find that group coverage across America is protected against pre-existing conditions and has been since 1996. You'll also find that group coverage through the leverage of the marketplace is able to get not only an inexpensive price but is able to get a product that most people like.

SHAPIRO: In your state of Kentucky, 400,000 people got coverage under the Affordable Care Act's expansion of Medicaid, and one of them is Brian Friedel, who has high blood pressure and had to stop doing construction work when he injured his neck. He spoke with my colleague Tamara Keith in July about what might happen if he loses the coverage the Affordable Care Act provides. Here's what he said.


BRIAN FRIEDEL: Maybe I have a heart attack and die. But how many other people that have even more strenuous conditions than I are going to have to die as a result of this?

SHAPIRO: Can you guarantee to somebody like Brian Friedel that if the expansion of Medicaid is not continued, his quality of care will remain the same?

PAUL: I think the goal of all of us is to have more insurance at a less expensive price. The insurance supplied by government - we have to decide how we're going to pay for it. So the great deceit and dishonesty of the Obamacare plan was that they put forward Medicaid expansion but didn't make anybody pay for it. They said, oh, it's free to the states. And so what state wouldn't like it? The problem is that the federal government doesn't have enough money to pay for the current Medicaid.

SHAPIRO: I'm not hearing a promise that the quality of care will remain the same, though.

PAUL: When you expand Medicaid, you have to be honest with the people, and you have to say how you're going to pay for it. This is also the fundamental fallacy of any kind of big government program. People say, oh, here's this. I have great compassion. I'm giving you something, but I'm not going to explain how we're going to pay for it.

SHAPIRO: That was Republican Senator Rand Paul of Kentucky. Transcript provided by NPR, Copyright NPR.

Corrected: September 21, 2017 at 12:00 AM EDT
A previous Web introduction to this story incorrectly said that Sen. Rand Paul has opposed all Republican efforts to replace the Affordable Care Act.