This article is more than 3 years old

This article is more than 3 years old

Rand Paul, one of the conservative senators who has helped to hold up Republican healthcare reform, on Sunday derided the current Senate bill as a “monstrosity” and a “porkfest” and said he would not vote for it to proceed to debate this week.

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With Donald Trump telling senators to stay in Washington until they have a replacement for Barack Obama’s Affordable Care Act (ACA), Mitch McConnell is reportedly looking to hold a vote to proceed to debate as early as Tuesday.

The Senate majority leader must attempt to win over conservatives such as Paul, of Kentucky, Ted Cruz of Texas and Mike Lee of Utah, who oppose government intervention in the insurance market.

Moderates such as Susan Collins of Maine have expressed opposition to the bill in terms of its $800bn cuts to Medicaid, the government programme that supports the young, elderly, poor and infirm.

“The real question is what are we moving to, what are we opening to debate to,” said Paul on CNN’s State of the Union. “Last week the Senate leadership said it would be a clean repeal, like the 2015 bill that we all voted for, and I think that’s a good idea.”

Obama vetoed the 2015 repeal, one of a succession of attempts by Republicans in Congress to bring down his signature legislative achievement.

Trump, eager for legislative success after six months in office without it, first said this week that the ACA should be repealed before a replacement was ready; then said it should simply be allowed to fail; then demanded a replacement at the same time as a repeal.

Paul continued: “The alternative is the Senate leadership bill that doesn’t repeal Obamacare, is Obamacare-lite and is loaded with pork; it’s become a porkfest where they’re dumping billions of dollars into pet projects for individual senators. I’m not for that.

“I’ve told them I will vote for a motion to proceed if we proceed to a clean repeal vote. If it fails they can put up their monstrosity that they want to put forward, but I’m not for that because I’m not for the taxpayer subsidising private industry.”

Speaking to CBS’s Face the Nation, Collins said uncertainty over what would be voted on this week was not “a good approach to facing legislation that affects millions of people and one sixth of our economy”.

The nonpartisan Congressional Budget Office said this week that repeal of the ACA without a replacement would lead to 32m Americans losing health insurance in the next decade.

The CBO score on the Senate healthcare bill put that figure at 22m. Republican healthcare proposals remain extremely unpopular with the voting public.

On Friday, the Senate parliamentarian threw another obstacle in the Republicans’ way. The chief rules adviser to the upper chamber said several provisions of the bill including the defunding of Planned Parenthood were not eligible for the 51-vote threshold of the budget reconciliation process and would have to attract 60 votes to pass.

The 48 Senate Democrats are united in their opposition to Republican attempts to repeal the ACA.

On Saturday, Trump included healthcare in a sequence of 10 morning tweets, writing: “The Republican senators must step up to the plate and, after seven years, vote to repeal and replace. Next, tax reform and infrastructure. WIN!

“Obamacare is dead and the Democrats are obstructionists, no ideas or votes, only obstruction. It is solely up to the 52 Republican senators!”

He then included healthcare in a speech to a military audience in Norfolk, Virginia, marking the launch of the USS Gerald R Ford, a new nuclear-powered aircraft carrier.

“You can … call those senators to make sure you get healthcare,” the president said, a political remark that some observers deemed inappropriate.

Ben Rhodes, a former senior adviser to Obama, tweeted that Trump’s words were “a huge deal. Obama (or Bushes) never would have done this. Violates most fundamental norms separating military and politics.”

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“The president is committed to repealing and replacing Obamacare,” said Sarah Huckabee Sanders, the new White House press secretary, on Sunday on ABC’s This Week. “Inaction is not an option and the president was making that clear yesterday and speaking not just to the people in the room but to the American people.”

On CBS, White House communications director Anthony Scaramucci was asked if Trump’s mixed messaging on healthcare could damage the Republican push for reform.

Trump’s contradictory tweets, Scaramucci said, showed the president “signaling over the top of the mainstream media”.

“He basically wants to repeal and replace Obamacare,” he said. “He knows that’s the best thing for the American people. It turns out that he may not be able to get that done with a recalcitrant Congress.”