Under pressure from President-elect Donald Trump, six years of expectations and more than 20 million Americans who could lose their health insurance, a Republican senator has offered first hints at what a replacement of the Affordable Care Act might look like.

Senator Rand Paul of Kentucky described details of his plan on Sunday, but did not say whether the 400,000 people in his state who have gained insurance under the existing law, often called Obamacare, would keep it under his own legislation.

Republicans in Congress have made repealing the ACA a priority, but hesitated for lack of a replacement that would not strip millions of Americans of health insurance.

“We need policies that create more jobs,” Paul told CNN’s State of the Union on Sunday, when asked directly whether his constituents would keep their coverage. “The more jobs we create the less need there is for government to jump in.”

His aim, he said, was to “give access to the most amount of people at the least amount of cost”.

This week, Republicans in Congress cleared the first hurdles towards repeal of the ACA, with Trump’s support.

An opthalmologist before entering Congress, Paul has been active on the issue of what the replacement should look like and how soon it should be passed into law.

Last week, he said he had spoken to Trump, who he said expressed support for his belief that a replacement should be introduced on the day of repeal. At a press conference in New York on Wednesday, Trump said he intended to replace the plan potentially at “the same hour” as repeal, but did not say how.

President Barack Obama has led Democratic calls for Republicans to say how they will replace the plan, saying he would publicly support some alternatives.

On Sunday Vermont senator Bernie Sanders, who ran strongly for the Democratic presidential nomination on a platform that promised to create a universal healthcare system, told ABC’s This Week that voters stood with him and the president. “The vast majority of the American people agree with me and many others,” he said, “you don’t simply repeal the Affordable Care Act without a replacement.

“Republicans have had six years to come up with a replacement. They got nothing.”

Sanders later appeared with Senate minority leader Chuck Schumer and Planned Parenthood president Cecile Richards at a rally in support of the ACA in Michigan, attracting a crowd of thousands.

Introducing his plan, Paul said: “I believe that it’s incredibly important that we do replacement on the same day we do repeal. We’ve had six years to complain, and we have complained, I’ve been one of those complaining about Obamacare, and replacement should be the same day.”



Paul said that the president’s healthcare plan had “failed” despite the good intentions of its authors. “But they put so many mandates in it that they made it too expensive,” he said.

“They’ve put in all these mandates that say every policy has to have things like pregnancy and dental coverage and all these things, which are great, but they add cost. They put people out of the market.”

Paul said his plan would “legalize the sale of inexpensive insurance”, adding: “That means getting rid of the Obamacare mandates on what you can buy.”

The senator said his bill would help people with health savings accounts and a tax credit, but that it would also help insurance companies that he said were losing money. He said his legislation would allow small businesses to band together to buy insurance for their employees.

Trump’s nomination to be secretary of health and human services, the Georgia congressman Tom Price, is due to attend Senate confirmation hearings this week.

An avowed opponent of the ACA, Price has drawn concern from senators over reports that he may have broken insider-trading lawswith healthcare companies.

In response to such reports and calls from Senate Democrats for an investigation, a Trump transition spokesman said Price had “complied fully with all applicable laws and ethics rules governing his personal finances”. The spokesman said Price would comply with the law if confirmed.