Sen. Rand Paul (R-KY) has issued a list of demands to the White House in order to obtain his vote on the Graham-Cassidy health care reform bill, according to a Sunday report by Axios.
The administration believes Paul represents the best hope for passing the bill, with Sen. Susan Collins (R-ME) seen as less likely to come over. In particular, they are banking on the warm relationship between President Donald Trump and Sen. Paul, a frequent defender of the administration during his televised appearances. Paul has negotiated directly with Trump, as well as Vice President Mike Pence, regarding this legislation.
The first demand is for a cut in the amount of block granted spending. This lines up closely with remarks made by Paul in recent interviews with the Washington Post and NBC News.
Paul also would like the bill to go further in getting rid of Obamacare regulations. Currently, the Graham-Cassidy bill permits states to opt out of Obamacare regulations. Paul would prefer to switch to a system where states would instead opt in to the Obamacare regulations.
Finally, Paul is also asking for an expansion of association health plans, which Paul Paul had also demanded this during the negotiations over the unsuccessful American Health Care Act (AHCA) earlier this year. Sen. Lindsey Graham (R-SC), the lead sponsor of Graham-Cassidy, has backed this proposal, saying he believes it could be “married up” with his own bill in order to provide an effective solution on health care. While this move cannot be incorporated into the bill under the rules of reconciliation, Paul has floated enacting the expansion via executive order.
Given Paul’s extensive demands, it remains unlikely that the White House will be able to placate him unless he agreed to compromise further. CNN‘s Jake Tapper stated on Monday night that Paul had told him earlier that day that he remained a firm no on the Graham-Cassidy bill. In addition, Sen. Lisa Murkowski (R-AK), a moderate Republican who opposed past repeal proposals but is still negotiating on Graham-Cassidy, would likely be dissuaded if the bill was pushed too far in Paul’s direction. However, given Trump’s reputation as an exceptional ‘deal maker’, it is impossible to rule out the prospect of a last minute agreement between Paul, the White House, and Republican moderates.