Mary Troyan

USA Today

WASHINGTON — Sen. Rand Paul voted Wednesday against the first step in repealing the Affordable Care Act because the underlying budget proposal increases the federal debt over 10 years.

Paul, a Kentucky Republican with a history of casting protest votes, was the only GOP senator opposed. After the 51-48 vote in the Senate, the budget resolution, which includes the mechanisms to start repealing the 2010 health care law in addition to general spending levels for the federal government over the next decade, will be debated for the next week.

Paul announced his opposition earlier in the day on MSNBC.

“I won’t vote for a terrible budget just to repeal Obamacare,” Paul said.

Paul’s opposition illustrates that even strong Republican critics of the Affordable Care Act have concerns over how to kill it without doing damage to the health insurance market, consumers and the larger American economy.

The proposed Republican budget — a key piece to the repeal effort — increases the federal debt by more than $9 trillion over 10 years, Paul said.

“If I have to weigh the two problems, I actually think the debt is a more important problem than Obamacare,” Paul said.

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Paul is so far the lone Republican dissenter in the Senate, but some of his fellow deficit hawks are also protesting the projected debt increase.

Sens. Mike Lee of Utah, Marco Rubio of Florida and Ted Cruz of Texas said they supported the 2017 budget resolution in order to repeal the Affordable Care Act, but they want the spending levels to be revisited in the 2018 budget.

“Our votes in favor of the ‘Obamacare Repeal Resolution’ do not indicate in any way our support for the revenue, and deficit numbers therein, nor for the use of those numbers as the basis for future federal budgets,” they wrote to Republican leaders.

Paul is also part of a growing Republican sentiment to have an alternative health insurance plan ready to immediately replace the repealed law.

“If they don’t, Obamacare continues to unravel and there are many health care experts and analysts predicting bankruptcy for insurance companies and a massive insurance company bailout within six months of repeal,” Paul said.

If the Affordable Care Act’s mandate for individuals to buy health insurance is repealed, for example, there will not be enough healthy people buying insurance to keep the plans solvent.

“It will be a huge mistake for Republicans if we don’t vote for a replacement the same day as the repeal,” Paul said.

Paul took to the Senate floor Wednesday afternoon to defend his vote and criticize the GOP for taking control of the House, Senate and White House and proposing a budget that doesn't dramatically cut federal spending.

"It's not a popular stand that I take today," Paul said. "The debt threatens the very foundation of our country."

Paul said he plans to introduce his own budget proposal, as in past years, that balances within five years.