Senate takes first step toward repealing Obamacare; Rand Paul, worried about deficit and debt, is only Republican to vote no

Paul, McConnell (Washington Post photo)

Citing concerns about the federal budget deficit and the national debt, Rand Paul of Kentucky was the only Republican senator to vote against a non-binding resolution that paves the way for repeal of the Patient Protection and Affordable Care Act.

Passage of the resolution early Thursday morning was led by Kentucky's other senator, Majority Leader Mitch McConnell, who said, "We must act quickly to bring relief to the American people."

Paul said in a press release, “As a physician, I cannot wait to repeal Obamacare and replace it with a health care system that relies on freedom to provide quality, comprehensive, and affordable care. But putting nearly $10 trillion more in debt on the American people’s backs through a budget that never balances is not the way to get there. It is the exact opposite of the change Republicans promised, and I cannot support it, even as a placeholder.”

The House may vote on the measure Friday, but "some Republicans there have misgivings about setting the repeal effort in motion without a better idea of the replacement plan," Andrew Taylor reports for The Associated Press.

President-elect Donald Trump said Wednesday that "Obamacare" would be replaced at virtually the same time it is repealed. "That promise, however, will be almost impossible to achieve in the complicated web of Congress, where GOP leaders must navigate complex Senate rules, united Democratic opposition and substantive policy disagreements among Republicans," Taylor writes. "Republicans are not close to agreement among themselves on what any 'Obamacare' replacement would look like."

Taylor offers background: "The 2010 law extended health insurance to some 20 million Americans, prevented insurers from denying coverage for pre-existing conditions and steered billions of dollars to states for the Medicaid health program for the poor. Republicans fought the effort tooth and nail and voter opposition to Obamacare helped carry the party to impressive wins in 2010, 2014, and last year."

Thursday's vote "set up special budget rules that will allow the repeal vote to take place with a simple majority in the 100-member Senate, instead of the 60 votes required to move most legislation," Taylor writes. "That means Republicans, who control 52 seats, can push through repeal legislation without Democratic cooperation. They're also discussing whether there are some elements of a replacement bill that could get through at the same time with a simple majority. But for many elements of a new health care law, Republicans are likely to need 60 votes and Democratic support, and at this point the two parties aren't even talking. . . . Increasing numbers of Republicans have expressed anxiety over obliterating the law without a replacement to show voters."

Paul has been working with members of the conservative House Freedom Caucus, who want to know details or put some elements of replacement in the repeal bill. "Some GOP senators have discussed a phase-in of three years or longer to give lawmakers more time to replace Obama's overhaul and make sure people now covered by that law can adjust to a new program," Taylor notes. "Some more moderate House Republicans were unhappy, too, including Rep. Tom MacArthur, R-N.J., a leader of GOP centrists in the House Tuesday Group. He said he would oppose the budget because there was too little information about the replacement, including whether people receiving expanded Medicaid coverage or health care subsidies under the existing law would be protected.

"We're loading a gun here," MacArthur said. "I want to know where it's pointed before we start the process."