Sen, Rand Paul, R-Kentucky, one of the conservative holdouts against the Senate version of the healthcare reform bill, signaled his willingness to make a deal that will allow him to switch his vote to a yes. While he favors a 100 percent repeal of Obamacare, he stated that he would certainly vote for 90 percent repeal and might be willing to accept 80 percent repeal. While he declined to reveal what percentage the current bill represented, it is clear that it is still below that threshold, the Washington Examiner suggested.

What does Rand Paul want?

Senator Paul would like to see an Obamacare repeal and replace bill that genuinely starts to lower the cost of health care and health care insurance premiums.

According to him (along with many others, including four other conservative senators), the Senate version of the bill does not do that since it maintains the Obamacare system of subsidies and the coverage mandates. In fact, it adds new money, some of it temporary, to shore up the Obamacare markets during a transition period.

One item that might sway Paul to switch his vote would be to allow the purchase of health insurance across state lines. This policy change would create a nationwide market for insurance that would create more competition and lead to premium reductions. Another provision that might tempt Paul would be one that would reinstate health insurance restrictions on people with preexisting conditions. The likelihood of that happening is all but nonexistent, however.

The problem with getting to 50 votes

One of the big problems with getting the 50 votes (plus Vice President Pence as a tie-breaker) is that the Senate Republican caucus contains a number of conservatives and moderates.

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If the reform bill goes one way, then more conservatives will drop off. If legislation goes too far the other way then the moderates will drop off. The Senate Democrats have vowed not to vote for any bill coming out of the GOP caucus no matter what it contains as part of a naked political ploy to cause a legislative train wreck in order to embarrass the majority of Republicans.

The other big problem has to do with the arcane rules of reconciliation. The Senate Parliamentarian rules on whether any provision of a bill is germane under reconciliation. If not, it goes out, or the bill will need 60 votes to pass, which presents a problem because of Democratic obstructionism. Hence, some provisions that might tempt the five conservatives to come on board without putting off the moderates cannot be included in a reconciliation bill.