After blocking partial repeal of Obamacare, Sen. Rand Paul is about to see Trump adopt his idea for association health plans

Rand Paul (By Pete Marovich, New York Times)

Kentucky Health News

U.S. Sen. Rand Paul of Kentucky "is in a precarious political position," writes Daniel Desrochers, political reporter for the Lexington Herald-Leader. "He’s the man who saved Obamacare. For now." But now Paul could argue that he is the man who is helping President Trump replace it, because Trump is about to adopt Paul's alternative idea for health insurance.

Paul was among three Republicans who said they wouldn't vote for the latest bill to repeal and replace the Patient Protection and Affordable Care Act. "couldn’t support the bill. John McCain, R-Ariz., said he couldn’t support the bill because too much was still unknown about how much it would cost and who it would help or hurt. Susan Collins, R-Maine, said she didn’t think the bill was good for the people of her home state," Desrochers notes. Paul was the only one who "refused to vote for the bill because it didn’t do enough to dismantle Barack Obama’s signature legislative achievement."

“I made a promise to repeal Obamacare, I went to rally after rally after rally,” Paul said Sept. 25. “I never had one person come up to me and say ‘Oh, what you mean by repeal is you’re going to keep most of the spending and you’re going to block grant it to the states.’ Nobody said that. This is not repeal, this is not what we promised.”

But some of Paul's supporters say it's time for him to deliver, at least partially, on the promise he made in his campaigns in 2010 and 2016.

“He needs to get in gear and just do it,” Kentucky Tea Party member Cindy Marlow told Desrochers. “We need to get something and it would be nice to get full repeal, but we need something. . . . Sometimes, the things we want, we're never going to get.”

Paul voted for two of the earlier repeal-and-replace bills that failed, and for his own bill, which would have repealed Obamacare but given Congress time to figure out a replacement.

For several weeks, he has said his idea to let people create health-care associations across state lines to purchase insurance will be adopted through an executive order by Trump. Saturday, administration officials said Trump was likely to issue the order this week.

"Such plans would in some ways be like large employers’ health plans, subject to some restrictions set by the Affordable Care Act, including a ban on lifetime limits, The Wall Street Journal reports. "But they would be free of other regulations, including the requirement that insurance plans cover a set package of benefits. These plans are popular with conservatives; some insurers fear that associations would peel off healthier and younger individuals and leave traditional insurance plans to cover sicker and older customers."

It remains to be seen how that approach will work. Skeptics, including the National Association of Insurance Commissioners, say it would undermine Obamacare's system of broad guarantees by allowing people to buy cheaper, less comprehensive policies and reducing the pools of policyholders in Obamacare plans.

“Its aim is clearly to do with the pen what Congress wouldn’t—eliminate pre-existing condition protections, essential benefit protections and lifetime caps and turn the ACA into a sparsely available high-risk pool,” Andy Slavitt, who ran Medicare and Medicaid in the Obama administration, told the Journal.

Paul spokesman Sergio Gor said, “We believe it will directly result in giving the American people more options to find low-cost and high-quality health care options.”

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.