Sen. Rand Paul is a quick ‘no’ on Senate health bill. Why he may not get to yes | McClatchy Washington Bureau

Now that Senate Republicans have unveiled their health care bill, the party looks to corral its more skeptical members who feel the legislation doesn’t do away with enough provisions created under the Affordable Care Act.

Senate Majority Leader Mitch McConnell can only afford to lose two Republican votes if he’s is going to get his heath care bill passed, and he’ll almost certainly lose his counterpart Sen. Rand Paul of Kentucky if changes are not made.

Paul was one of four conservative senators who quickly announced Thursday they’ll oppose the bill in its current form.

“The current bill does not repeal Obamacare,” Paul said in a statement. “It does not keep our promises to the American people. I will oppose it coming to the floor in its current form, but I remain open to negotiations."

Paul, who leans libertarian, wants a full repeal of the Affordable Care Act, specifically calling for the removal of subsidies that are used to assist low-income plan members and Medicaid recipients. The new bill would change the payouts but keep many of the subsidies, and Paul said he believes it would end up costing more than Obamacare next year.

“It’s going to be hard for conservatives to support a bill that has greater subsidies than Obamacare,” Paul said. “That to me is really a non-starter.”

Many Republicans, including Paul, were left out of deliberations regarding the legislation, with party leaders holding several closed meetings over the past few weeks leading up to the reveal. Senators were briefed on the bill’s details Thursday morning, and McConnell said a vote is approaching next week pending a score from the Congressional Budget Office.

Three other conservatives, Mike Lee of Utah, Ted Cruz of Texas and Ron Johnson of Wisconsin, also said Thursday they won’t support the bill in its current form but are open to negotiations.

Other wavering senators in McConnell’s caucus, such as moderate Sens. Susan Collins of Maine and Lisa Murkowski of Alaska, worry the GOP’s plan would knock too many people off health insurance.

Paul also takes issue with Medicaid under the new Senate bill because of his home state’s experience, saying it was dishonest to tell people that the federal government would fund Medicaid expansion under Obamacare and then have the states bear part of the burden. He said Kentucky would have to weigh either cutting back on Medicaid or doubling the state income tax to fund it.

“If you want Medicaid, we have to agree how to pay for it,” Paul said.

From 2013 to February of this year, Kentucky’s Medicaid/CHIP enrollment increased 105 percent, the most of any state, according to the Kaiser Family Foundation, which conducted a survey in 2015 that found 63 percent of Kentuckians have a favorable view of Medicaid expansion.

Gov. Matt Bevin, a Republican who was elected in 2015, campaigned and promised to entirely cut Medicaid expansion but then softened his position, seeking a section 1115 waiver from the federal government that would allow the state to create its own version of Medicaid expansion. The waiver proposal is still under review.

“Kentucky has probably been helped more than any other state under Medicaid expansion,” said Al Cross, director of the Institute for Rural Journalism at the University of Kentucky. “(Paul) knows the value of Medicaid.”

Although Medicaid expansion gave more Kentuckians the right to health care, Michael Cannon, director of health policy studies at the libertarian-leaning Cato Institute think tank, agrees with Paul’s assessment that increasing the number of people guaranteed care does not lead to those people receiving better or more affordable care.

Additionally, Cannon said he sees no value in subsidizing health plans that remain unaffordable for low-income plan members. “Senator Paul is absolutely right,” Cannon said. “The entire approach of Affordable Care Act is to throw government money and taxpayers’ dollars at unaffordable care rather than make care affordable.”

Paul said the Republican’s approach to drafting this bill was significantly rushed. In response he introduced legislation Wednesday that would require bills, amendments and conference reports to be filed one day for every 20 pages in advance before they can be considered by the Senate.

“If you do it on one side only, what you’re setting yourself up for is failure,” Paul said. “The public is not going to accept it if only one side does it.”