Sen. Rand Paul says round one of healthcare negotiations may be over in Washington, but he’s keeping hope alive on piecemeal reforms – and lobbying hard for an executive solution.
The Bowling Green lawmaker made a brief swing through Lexington Friday for a roundtable with about a dozen constituents concerned about the breakdown of GOP health reform efforts on Capitol Hill. The leading conservative's message: he’s not giving up.
With the Republican majority repeatedly falling short of consensus on a bill to repeal and replace the Affordable Care Act, also known as Obamacare, Paul has shifted his focus to expanding what are called “association health plans,” or AHPs, allowing more individuals and small groups to band together and boost their bargaining power.
And he says he’s got the commander-in-chief's ear on the issue.
"We have an idea that's a very practical idea that might come forward next month, and I think that President Trump agrees with me on it, so I think we might actually get it done, even without legislation," the senator told reporters. "I think he can do it through presidential authority."
Paul even tacked a percentage on the chances, indicating he's "90 percent" certain Trump will sign on in the coming weeks. In the meantime, Kentucky's junior senator is investigating options on the state level, sitting down with Gov. Matt Bevin.
"I've met with his people before. I've talked with him, but I want to see what we can do to make healthcare better for people in Kentucky," Paul said.
The senator is predicting that, within a year, some Kentucky counties will be without a single health insurer in the individual market.
Those concerns and others were echoed by a sympathetic group of roundtable attendees Friday, who also worried aloud about a physician shortage in the commonwealth, GOP messaging, and a political pendulum swing toward a single-payer system if Republicans fail to notch a win on healthcare before the 2018 midterm elections.
Doubters contend expanded associations would continue to push sicker patients into higher cost plans in the individual market.
Ashley Spalding with the left-leaning Kentucky Center for Economic Policy writes: "AHPs could be far less comprehensive than regular insurance coverage in a state’s individual and small-group markets, and AHP enrollee premiums could be set based on people’s health status and risk. This creates a sharp disparity that would lead healthier people and small groups to flock to the AHPs, in order to get cheaper premiums."
Confidence In McConnell
Paul says Senate Majority Leader Mitch McConnell still has his support, despite increasingly pointed swipes from the president on Twitter and in interviews.
In his third tweet directed squarely at the majority leader, Trump tweeted Thursday: "Mitch, get back to work and put Repeal & Replace, Tax Reform & Cuts and a great Infrastructure Bill on my desk for signing. You can do it!"
The comment ended on a seemingly encouraging note, while also laying down conditions for his support of McConnell: replace the Obama-era health law, overhaul the U.S. tax system, and make headway on infrastructure. Quizzed by reporters on whether McConnell should step down, the president suggested a wait-and-see approach on the Obamacare repeal. "Then you can ask me that question," he said.
Paul hasn’t always seen eye-to-eye with his Kentucky colleague – most recently parting ways on early versions of the Senate healthcare bill – but he insists avenues still exist to enact piecemeal health reforms and he's staying optimistic.
"We can always focus on the contention," Paul said. "I'm a glass-is-half-full kind of guy. I want to focus on something (that) could... happen."
Notes On North Korea
With rhetoric between North Korea and the United States escalating, Paul urged the Trump administration to make it clear that the U.S. is not angling for regime change.
While the former GOP presidential candidate says observers might view President Donald Trump’s warnings as an indirect message to China to step up pressure on the North Korean regime, he would like to see the U.S. cool down the war talk.
"I think the messaging is important," the senator said. "I'm concerned that we not ratchet it up, that something irrational happens. A war in the Korean peninsula would be devastating to all sides."
Following successful tests of intercontinental ballistic missiles capable of reaching the U.S. mainland, Trump has promised to unleash “fire and fury” if threats continue, adding Friday that military solutions are “locked and loaded” should North Korea act unwisely.
Paul said North Korea should understand the U.S. will defend itself and South Korea, but that that it has no designs on regime change or occupation.