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Senator Rand Paul (R-Ky.) has sent Majority Leader Mitch McConnell a list of priorities that he feels should be included in an improved version of the health care bill.

Paul said that while he appreciates the inclusion of Small Business Health Plans in the BCRA, improvements could be made to “allow for greater freedom for individuals and small businesses to pool together for the purpose of obtaining health care coverage.”

“The bill currently allows for self-employed individuals to participate in small business health plans,” Paul’s letter says. “However, I would suggest that the language be changed to allow any individual, including self-employed individuals, to form associations for the purpose of purchasing group health insurance.”


“Furthermore, I would suggest that small business plans or association health plans be allowed to self-insure like other large employer groups are able to do under ERISA. Self-insurance provides significant flexibilities to create innovative plan designs free from many mandates.”

In addressing the reduction of regulations, Paul said there’s a real opportunity to make helpful changes.

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As for insurance company bailouts, codified in the BCRA through at least the next four years, Paul was critical and reminded conservatives of their concerns over bailouts under the Obama administration.

“For years, conservatives have been concerned with Obamacare’s bailout of the insurance companies through various programs designed to backfill losses the insurers take in the Obamacare exchanges, while they make huge profits in the group markets,” he said. “In fact, insurance company profits were $8 billion per year in 2008, and have risen to $15 billion in 2015.”

“The BCRA’s payment of Obamacare’s cost-sharing reductions, as well as its stability funds, would provide another $136 billion in funding to pay insurance companies to participate in these markets. I urge you to reconsider this insurance company bailout,” he added.

Paul also expressed concern over the BCRA’s premium tax credits, reminding Senate leadership of their vote against Obamacare’s premium tax credits in 2015.

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As for the continuous coverage requirement, which locks consumers out of the individual insurance market for six months if they don’t maintain coverage, Paul said it looks like just another version of the individual mandate under Obamacare.

“This continues the top-down approach that has led to increased premiums and has not changed behavior of the young and healthy who are priced out of the market, and those who game the system to purchase insurance after they become sick,” he warned.

Paul concluded on a hopeful note, saying he wants Republicans to keep their promises.

“I hope that this outline aids your understanding of my current position on the Senate health reform bill, and changes that might be made to the language to make good on Republicans’ promise to stop Obamacare and provide true health reform,” he said.

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