Senator Rand Paul, the Kentucky Republican, has one thing right: The latest Republican bill on health care is not a repeal and replacement of Obamacare. Under it, the Affordable Care Act’s taxes, spending, and regulation would mostly remain in place. Of course, previous Republican bills left a lot of Obamacare in place, too. For many months it has been clear that Republicans do not have the votes for a true replacement.
Where Paul is wrong is in opposing the Graham-Cassidy bill on that basis. A true replacement of Obamacare would be better than Graham-Cassidy, but Graham-Cassidy is still much better than Obamacare. It abolishes the individual and employer mandates, caps per capita spending on Medicaid, blocks federal funds from going to insurance plans that cover abortion, and lets interested states attain freedom from some of Obamacare’s regulations. Some of those states could use that freedom to create markets in which people outside of Medicare, Medicaid, and employer-based coverage would finally be enabled to buy cheap, renewable catastrophic-insurance policies.
The senator’s objections to the bill amount to a case for improving it, perhaps in a conference committee after it passes the Senate. They do not amount to a case for voting it down. The bill goes farther in the right direction than the “skinny repeal” bill for which Paul voted earlier this summer. That bill abolished only the individual and employer mandates.
If Graham-Cassidy fails, we will still support changing Obamacare — in this Congress or a future one. But everyone understands that its failure will drastically reduce the likelihood of making any conservative changes to Obamacare for the foreseeable future. There has been widespread speculation that Paul is playing a game on Obamacare: that he does not really wish to see major changes to it and will find libertarian-sounding objections to any Republican bill that has a chance of passage. This speculation may be unfair. But Paul’s arguments for a no vote make so little sense, and are so hard to square with his previous votes, that it is getting harder to dismiss.