Just yesterday, I posted about how, if the Republicans were approaching things in a normal strategic manner, Susan Collins would run the show on repealing and replacing Obamacare. She is essentially the pivotal Senator. Get Collins on board, and Republicans can pass their legislation. Lose Collins and two more, and that's it. That's all she wrote. In yesterday's post, I mentioned that the reason things are still messy is that the right wing of the party might not go along with Collins-Cassidy, even though it moves policy to the right and failure to pass it might leave Obamacare in place.
And Rand Paul is pretty much doing what I said. He has a proposal that basically gets rid of all subsidies from Obamacare that individuals use to buy health insurance when they don't get it through employers. Why? He's very conservative. He hates redistribution. Collins-Cassidy keeps too much redistribution for his taste.
Rand Paul is important for two reasons here. First, he represents the extreme wing of the party. He hates compromise. Second, he is right there with Collins in one respect-- he won't vote for a repeal unless Congress passes a replacement at the same time. In other words, if Collins and Paul can't agree on a replacement, neither will vote for a repeal.
And their replacements look nothing alike. And Paul really doesn't like Collins-Cassidy. If one or both of them doesn't cave, Obamacare stays in place.