Rand Paul and Obamacare Replacement


It must be nice to be Sen. Rand Paul (R-KY) and live your life where only “perfect” is acceptable and mere progress is bad.

The Senate Republicans are close to taking up a last ditch effort to repeal Obamacare utilizing a proposal by Sens. Lindsay Graham (R-SC), Bill Cassidy (R-LA), Ron Johnson (R-WI) and Dean Heller (R-NV). The essence of the bill is to reduce Medicaid expansion, eliminate the individual mandate, and redistribute existing financial support for Obamacare to the states in the form of block grants. Mr. Paul immediately declared his opposition to the bill branding it “Obamacare light” – a sobriquet that Mr. Paul has applied to virtually every proposal to repeal and replace Obamacare.

You see Mr. Paul, like his father before him (Rep. Ron Paul (R-TX)), is a purist – a free market, small government Libertarian. There is nothing wrong with that and, in fact, it is important that someone like Mr. Paul continues to promote those concepts to remind us that this country was made great utilizing the free enterprise concepts of robust competition, limited governmental interference and individual responsibility. In doing so Mr. Paul draws a bright line between the past progress of America and the more recent slide into the welfare state where the well being of government has now supplanted individual rights and responsibilities.

Mr. Paul has promoted a stand-alone repeal of Obamacare – a repeal unaccompanied by a replacement. He points to a series of votes over the last several years when virtually every Republican senator voted to repeal Obamacare – including Sens. Susan Collins (R-ME) and Lisa Murkowski (R-AK) who have now succumbed to the lobbyists and hefty campaign contributions of the pro-abortion lobby and thus voted against the repeal and replace measure in the Senate this year. But those were all votes that counted for nothing because the Republican senators knew that then-President Barack Obama (D) would veto any such legislation. It is unclear whether Mr. Paul demands the stand-alone repeal as a matter of principle or simply as a means of demonstrating the hypocrisy of his Republican colleagues who have run their mouths for repeal over the last seven years without a clue as to how to actually accomplish it. I choose to think it is a little of both.

However, Mr. Paul actually has a plan to replace Obamacare – it is just not a government involved plan. (That is in marked contrast with the despicable Sen. John McCain (R-AZ) who simply opposed the previous Senate plan so as to deny President Donald Trump a victory and who had absolutely no alternative plan to promote.) It is a pure free market plan which simply allows individuals and businesses alike to band together in forming collaborative purchasing entities of sufficient size to force health insurance companies to bargain with them for coverage – think AARP using the collective economic might of its 55+ membership in negotiating Medicare supplemental coverage with UnitedHealthcare. Because it is a free market solution all it requires for implementation is for the federal and state governments to get out of the way – in this case it means a federal law prohibiting states from barring individual health insurance providers as they now do currently using protectionist regulations.

Mr. Paul has acknowledged that any such plans would require pre-existing condition coverage. Presumably such negotiated plans will provide flexibility that allows such things as single men not being required to purchase ob-gyn or pregnancy coverage, single women not being required to purchase coverage for prostate health or erectile dysfunction, or abortion coverage for those who oppose abortion as a matter of conscience.

The problem with Mr. Paul’s plan is that it cannot pass the United States Senate. In all probability it cannot garner more than one vote in the Senate – Mr. Paul’s vote. Regardless of its worth, the other Republicans will run from it like it was the plague because the non-partisan, but highly biased*, Congressional Budget Office (CBO) will “score” Mr. Paul’s measure as resulting in the loss of coverage for tens of millions of Americans (the expanded Medicaid crowd and those burdened by the individual mandate) and the Democrats will gleefully roll out videos of Mr. Paul pushing Grandma in her wheelchair over a cliff (even though Mr. Paul’s proposal has nothing to do with Medicare which provides Grandma her healthcare).

However, there is a solution. Senate Majority Leader Mitch McConnell (R-KY) should allow Mr. Paul’s stand-alone repeal bill to come to the floor accompanied by Mr. Paul’s free-market buying collectives authorization and let it stand for a vote. And Mr. Paul, in exchange, should commit to supporting the Graham-Kennedy measure amended to include the free-market buying collective authorization, should Mr. Paul’s stand alone repeal fail.  There is an added benefit to such a solution in that it will allow Reps. Jim Jordan (R-OH) and Mark Meadows (R-NC) along with the other members of the House Freedom Caucus to clearly see that a stand alone repeal is not possible in the Senate and thus reinforce their current decision to support the Graham-Kennedy proposal.

I don’t disagree with Mr. Paul that the Graham-Kennedy measure is, to a degree, Obamacare light. But it is progress. Whatever it is it is better than Obamacare which is out of control and failing. Shifting the responsibility for administering healthcare coverage and Medicaid to the states allows for greater flexibility in design, efficiency and accountability. If a state like Idaho decides that it wants to impose conditions on Medicaid eligibility – drug testing, workfare for the able-bodied, or elimination of abortion coverage it should be allowed to. If a state like Oregon wants to make abortion (including partial birth abortion) mandatory and utilize its funds to increase benefits for SEIU union members, it can.

In the end, how each state treats healthcare coverage will become, like taxes and business regulation, a competitive factor in attracting and retaining people. My guess is that the result would be an increased flow of business and skilled workers to places like Idaho and a continuation of the migration of welfare recipients and public employees to places like Oregon and California.


*The Congressional Budget Office is populated with career public employees just like the other federal agencies of the government. Regardless of their nominal party affiliation they are overwhelming big government acolytes who recognize that government provides them with unlimited job opportunities and security. The CBO’s history in accurately scoring (predicting) federal legislation is abysmal and routinely favors continuation and growth in federal programs as opposed to reduction or elimination of such programs.