Sen. Rand Paul taking questions from the media about the Graham-Cassidy bill in Louisville on Monday. | Photo by Joe Sonka

Sen. Rand Paul told reporters in Louisville on Monday that he remained opposed to the Graham-Cassidy bill expected to be voted on in the U.S. Senate this week, which is billed as another Republican effort to fulfill their promise to repeal and replace the Affordable Care Act.

Paul had already expressed his opposition to the bill last week — saying it did not go far enough in repealing the infrastructure of “Obamacare” — but over the weekend, the sponsors of the bill added sweeteners for the states of Republican senators who remained critical of or undecided on the legislation. Kentucky, Maine, Alaska and Arizona were expected to lose Medicaid funding through 2027 in the original legislation, but the amended bill reportedly increases the total that each state would be block granted.

While Paul said Monday that he was still looking at the changes in the bill, he maintained that he was still a “no” vote on Graham-Cassidy.

“My concern still is that the main thing this bill does is reshuffle the money from Democrat states to Republican states, but doesn’t fix the problem,” said Paul. “My concern still is that we have a $700 billion deficit and I think this bill basically immortalizes the spending. The spending will go on and on and on, and I don’t think anybody’s taking account for what that does to the deficit.”

Asked by IL what he thought about the new tactic of moving additional Medicaid funding to the states of senators who are key swing votes, Paul answered: “It looks suspicious, doesn’t it? I’m not for doing that.”

“I’ve seen three or four different reports where Kentucky does better or worse,” said Paul. “And the thing is, if all we’re doing is shifting money but basically keeping the system, I don’t know that we’ve fundamentally changed anything other than reshuffling who gets the money. And that’s going to make some people happy and embitter other people. So I don’t think it’s the answer.”

If Paul and Sen. John McCain, R-Ariz., remain a no vote on Graham-Cassidy, that means Republicans cannot afford to lose a single more vote, with Sen. Susan Collins, R-Maine, and Sen. Lisa Murkowsi, R-Alaska, reportedly leaning against the bill. According to CNBC, whereas Alaska, Arizona, Maine and Kentucky would each lose billions of Medicaid funding under the earlier version of the bill, they would now gain $1.4 billion, $4.2 billion, $1.5 billion and $1.1 billion, respectively.

Sunday evening, President Donald Trump tweeted that “Alaska, Arizona, Maine and Kentucky are big winners in the Healthcare proposal. 7 years of Repeal & Replace and some Senators not there.”

Asked if he thought the bill would pass, Paul said, “I think it’s going to be very close,” adding that he does not think McConnell will put Graham-Cassidy up for a vote if it lacks 50 supporters.

Paul repeated that while he likes some aspects of Graham-Cassidy — such as getting rid of the individual mandate and strengthening health savings accounts — he said that in order to fix the system “we need more of a marketplace, we need to let individuals buy insurance across state lines, and we need to let people buy inexpensive insurance. That means more freedom in the marketplace.”

Expanding on his criticisms of the bill, Paul said that it would create a “formula food fight,” in which Democrats and Republicans shift around Medicaid money under the Affordable Care Act depending on which party is in power at the time.

The bill “block grants the Obamacare money, but keeps it, but then it takes it from big states like California and New York and Maryland and Massachusetts – which just happen to be Democratic states – and passes it out to all of the Republican states,” said Paul. “And when the Democrats win what are they going to do? I’m guessing there will be another formula food fight and they’ll try to claw back the money to their states. That’s not the way to fix this thing.”

Paul still hopes that future legislation will allow health insurance consumers to purchase plans in large groups that cross state lines “to get the leverage of purchasing less-expensive insurance that would also have all of the protections that people want.” He added that whether or not the current bill passes, Trump has assured him that “he is going to expand the definition of who can be part of an association, which “will happen in the next couple of weeks.”

Paul says this change would “cost nothing” and begin to show beneficial effects in six months to a year, expressing hope about the possibilities of health consumers joining a wide variety of groups, from credit unions to retailers.

“One of the things I’m most excited about is we have two million fast-food restaurants in our country, they employ about 15 million people,” said Paul. “I think we could have a pool of 15 million people who can get their insurance with one person negotiating the rate. A lot of these people don’t have any insurance, even under the current system. So, I think this would be exciting. Let’s try to do some good things like that.”

Sen. Mitch McConnell remains supporting of Graham-Cassidy, while Congressman John Yarmuth says it will jeopardize the health and coverage of hundreds of thousands of Kentuckians who could lose their insurance and protections against discrimination for having pre-existing conditions and lifetime caps on benefits. On Monday afternoon, Yarmuth released a statement on the latest version of the Graham-Cassidy bill, saying the legislation “uses phony numbers in an obvious and irresponsible attempt to buy votes for its passage.”

“What is real about this bill is the incredible damage it will inflict on the entire country,” stated Yarmuth. “Families in my home state of Kentucky and throughout the country would be far worse off should this legislation pass. Instead of waiting for the non-partisan analysis of the Congressional Budget Office, the bill’s sponsors are making up their own numbers and hoping no one notices. The truth is that funding for expanding health coverage in Kentucky would be cut, protections for people with pre-existing conditions such as asthma, autism, and diabetes would be gutted, rural hospitals would be endangered, and Medicaid as we know it would end.”

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Joe Sonka
Joe Sonka is a staff writer at Insider Louisville focusing on government, politics, education and public safety. He is a former news editor and staff writer at LEO Weekly and has also freelanced for The Nation and ThinkProgress. He has won first place awards from the Louisville Metro chapter of the Society of Professional Journalists in the categories of Health Reporting, Enterprise Reporting, Government/Politics, Minority/Women’s Affairs Reporting, Continuing Coverage and Best Blog. Email him at [email protected]