Brendan Hoffman/Getty Images

Rand Paul is leaving Trumpcare up to John McCain.

A decent rule of thumb over the past eight months has been that Paul will support any health care bill or process he knows will result in failure and therefore preserve Obamacare, which—by pure coincidence—insures about half a million people in his home state.

Obamacare has been a bigger boon to Kentucky, on a per capita basis, than just about any state in the country. Paul meets his political obligation to protect those benefits by issuing demands that allow him to tout his ideological purity while keeping his hands clean of Trumpcare.

In a new oped for The Hill, Paul says he will oppose beginning debate on a Republican health plan unless he receives a commitment from GOP leadership that the first substantive vote before the Senate is to repeal all of Obamacare’s taxes and spending.

[I]f that’s what our leadership finally decides to move to first next week, I’ll vote to proceed to the debate, and I’ll vote for repeal.

What is the alternative? A pork-laden bailout bill that doesn’t repeal ObamaCare. That’s the current Senate leadership bill. The bill fails at its mission to repeal by leaving most of the ObamaCare taxes and regulations in place, while also loading us up with $200 billion in bailouts for rich insurance companies, who’ve seen their profits double under ObamaCare.

I won’t be a part of that. I won’t vote for it, and if that’s the bill the leadership intends to turn to, I won’t vote to proceed to the floor. It’s that simple.

I don’t see any way to read this demand other than as a promise to oppose the Senate GOP health care bill, whether at the outset of debate or at the end of it. If GOP leaders accede to his demand, then at some point late this week or early next, Senate Majority Leader Mitch McConnell will introduce Paul’s plan, which will fail. After that, Paul will be back to railing against Trumpcare as a “pork-laden bailout.” Alternatively, leaders can reject his demand, in which case he’ll vote against the motion to begin debate on Tuesday.

As long as Arizona Senator John McCain is recuperating from surgery related to his just-diagnosed brain cancer, McConnell can only lose one vote. We know that Maine Senator Susan Collins is a no. Paul won’t be a yes unless GOP leadership gets behind an amendment that can’t pass the full Senate. The bill goes down, in other words, unless McConnell runs the table with every other Republican, and then McCain rides to its rescue.