Sen. Rand Paul (R-Ky.) speaks to reporters in July. (Joshua Roberts/Reuters)

Of all the contradictory and confusing positions Republicans have taken this year as they try to repeal Obamacare, the one Sen. Rand Paul (R-Ky.) has staked out is the most head-scratching to Washington.

He's the Senate's only firm “no” right now one of two solid "no" votes on a version of Obamacare repeal the Senate could vote on next week. GOP leaders can afford only two defections and are trying to convince at least three other skeptics.

Paul's position is perplexing for a couple of reasons:

  1. He voted for a lesser Obamacare repeal bill in July.
  2. The bill he opposes is one of Republicans' likeliest chances to repeal most of Obamacare in the near future.
  3. He is the only one of 52 GOP senators who is willing to vote against a last-chance effort to repeal Obamacare because it doesn't go far enough.

And his answer comes down to principle: Get rid of all of Obamacare, or bust.

Some of the other senators leaning against the bill have concerns about the rushed process, or how the bill could leave millions uninsured, or how their governors feel about it. This bill goes too far in undoing government's role in health care, they argue.

We don't yet have official estimates of the bill's effects from the nonpartisan Congressional Budget Office, but several health-care analysts The Fix spoke to say the bill is among the most conservative Congress has seriously considered.

It drastically cuts Medicaid. It slashes federal funding for health care, and it ends Obamacare funding (unless Congress restarts it) altogether in 2026. It lets states apply for waivers to get insurers out of virtually every Obamacare regulation. More than a dozen patient and medical groups oppose it, as do at least five Republican governors.

This bill isn't perfect, say its supporters, but it's the best chance they've got to make good on their central campaign promise for the past seven years.

“You know, I could maybe give you 10 reasons why this bill shouldn’t be considered,” Sen. Charles E. Grassley (R-Iowa) said in a conference call with Iowa reporters. “But Republicans campaigned on this so often that you have a responsibility to carry out what you said in the campaign. That’s pretty much as much of a reason as the substance of the bill.”

Paul, almost uniquely, sees this differently. If states want to keep all of Obamacare in place, they can, he points out. (Although there will be less money to pay for it.) For the states that want to repeal Obamacare, Paul doesn't trust the government to give them waivers to do it. (Despite the fact the bill says the Health and Human Services secretary has to.)

“I’ve already spent the better part of the year arguing with an army of bureaucrats and lawyers in the administration trying to get them to do something President Trump and I AGREE should be done — loosening up the rules on joining group plans,” Paul wrote in a Fox News op-ed this week.

It's a principled stand that ignores the political realities, argue some of his colleagues.

“We all know that some folks would rather have a bill that’s perfect,” Sen. Mike Rounds (R-S.D.) told Politico of Paul. “But I guess if we can’t have a bill that’s perfect, I’d rather have a bill that’s much better than what [the law] is today.”

And yet it's a stand Paul, perhaps more than any other senator, can afford to take.

The governor of his state has also tried to rip Obamacare apart, although Gov. Matt Bevin (R-Ky.) supports the current legislation that Paul opposes. Senate Republican leaders have long ago stopped trying to persuade Paul to go against the grain, so he's getting little to no pressure there. And he staked out a repeal-or-bust position pretty early on in this debate. He dragged a copy machine (and reporters) across the Capitol in March to make a big show of how House Republicans were drafting a bill in secret that he feared wouldn't be a full repeal.

Paul's votes have been a little more complicated than his public positions.

This summer, Paul got the Senate to vote on a moon shot repeal without replacement, which failed. (Repeal-sans-replace would wreak havoc on health-insurance markets, analysts warn.)

But days later, he voted for a “skinny repeal” bill that kept most of Obamacare in place.

“What we have to try to do is rip out as much of the terrible distortions that Obamacare has caused and then we fight on,” he told Fox News's Neil Cavuto after July's vote.

His staff says Paul's argument then was that no repeal is better than nothing, as long as it leaves the replace fight for another day.

The Cassidy-Graham bill the Senate could vote on next week would be pretty much it for Congress's involvement in health-care policy in the near term. A majority of GOP senators think doing something is better than nothing. A handful are worried that doing something is worse than doing nothing. And Paul is concerned that this something isn't good enough.

And that is the epitome of why Republicans have struggled for nine months and counting to repeal Obamacare. Repeal is in the eye of the beholder.