At the end of July, Kentucky senator Rand Paul advocated and voted for the so-called “skinny repeal” bill of Obamacare. “Skinny repeal is better than no repeal,” Paul said on Fox News. “The reason I will advocate and vote for skinny repeal is that it’s the best I can get.”
But now that Republicans are trying to take one last shot at Obamacare by passing the Graham-Cassidy bill, Paul is adamantly opposed to the “better than nothing” argument. “It keeps 90 percent of the spending of Obamacare and reshuffles it,” Paul told reporters on Monday, dismissing Graham-Cassidy as “Obamacare Lite.”
“If you asked any conservative up here—’Would you vote for a brand new trillion dollars in taxes, trillion dollars in spending and then we’ll call it federalism by redistributing it and giving it out to the states?’—most people would laugh at you. But because this already exists people are saying, ‘Oh well, it’s better than what we’ve got.'”
“This is not repeal, and I’m not for it,” Paul said.
Paul’s decision to support “skinny repeal” but oppose Graham-Cassidy is more than a bit puzzling because Graham-Cassidy would repeal more of Obamacare than the “skinny repeal” would have.
Both bills would axe the individual mandate, the employer mandate, the medical device tax, and federal funding for Planned Parenthood. But Graham-Cassidy repeals more of Obamacare in a few ways:
1. The skinny bill provided states waivers that would give them more freedom from Obamacare’s regulations, but Graham-Cassidy’s waivers are much broader.
2. While both bills would defund Planned Parenthood, only the Graham-Cassidy bill would achieve the more important pro-life policy of cutting off Obamacare’s funding of insurance plans that cover elective abortions.
3. The skinny bill didn’t reform traditional Medicaid at all; Graham-Cassidy bill does.
4. While the skinny bill kept all of Obamacare’s spending, Graham-Cassidy keeps most of the spending and sends that money back to the states in the form of block grants that must be spent on health care.
While these differences would all seem to make Graham-Cassidy better from a conservative perspective, Paul says that block-granting the money to the states makes Graham-Cassidy unacceptable.
When asked Tuesday why he voted for an Obamacare repeal bill that kept 100 percent of Obamacare’s spending, but opposes a bill that keeps 90 percent of Obamacare’s spending, Paul told THE WEEKLY STANDARD: “This affirmatively votes for a distribution system for a trillion-dollar program. The other didn’t. The other simply was silent on it.”
Paul’s arguments about Obamacare’s spending have shifted over the last few days. While on Tuesday he defended a vote for the skinny bill because it was “silent” on Obamacare’s spending, on Monday he seemed to argue that any bill that didn’t affirmatively cut Obamacare’s spending would be unacceptable.
Paul’s opposition to the block-grant approach is all the more puzzling because in July Paul voted for an amendment that would have block-granted most of the Obamacare spending. For procedural reasons, the block-grant approach is believed to be the only realistic way the Senate can stop Obamacare funding from paying for insurance plans that cover elective abortion.
Given his past comments and voting history, Paul seems more opposed to the particular way Graham-Cassidy distributes the block grants and not the overall amount of Obamacare spending it retains or the mere principle of block-granting Obamacare’s spending.
“It takes money from the Democrat states and gives it to the Republican states,” Paul said on Monday. Because the bill redistributes all of Obamacare’s spending nationwide, states that expanded Medicaid under Obamacare like California and New York would get less than they would under the Obamacare status quo, but non-expansion states like Virginia and Wisconsin would get more. Paul’s Kentucky expanded Medicaid.
While some governors of Medicaid-expansion states have opposed Graham-Cassidy, some Republican governors are willing to trade less funding for more flexibility. Arizona governor Doug Ducey, for example, offered a full-throated endorsement of the bill despite the fact that Arizona wouldn’t get as much federal funding as it would under Obamacare. Kentucky governor Matt Bevin, in a letter with other GOP governors, endorsed the central idea behind Graham-Cassidy but emphasized the need for “adequate funding.”
Yet Paul seems to be unmovable on the issue. “Rand Paul is a friend of mine but he is such a negative force when it comes to fixing healthcare,” President Trump tweeted on Wednesday morning. Paul replied on Twitter: “#GrahamCassidy is amnesty for Obamacare. It keeps it, it does not repeal it. I will keep working with the President for real repeal.”
