115th Congress (2017–2019)
In March 2017, Paul introduced the Stop Arming Terrorists Act that would prohibit the use of United States government funds to provide assistance to Al Qaeda, Jabhat Fateh al-Sham, and the Islamic State of Iraq and the Levant (ISIL) and to countries supporting those organizations. On March 16, Senator John McCain (Rep) accused Paul of being an agent of Vladimir Putin after Paul objected to adding Montenegro to NATO. Paul responded the following day by saying McCain "makes a really, really strong case for term limits", suggesting McCain had become "a little unhinged" as a result of his seniority. On April 7, McCain said he did not pay attention to any of Paul's rhetoric and that the latter did not have "any real influence" in the United States Senate.
Paul questioned President Trump's April 2017 missile strike to Syria by saying, "While we all condemn the atrocities in Syria, the United States was not attacked." He said that further action should not be taken without congressional authorization.
Paul was one of 22 senators to sign a letter to President Donald Trump urging him to have the United States withdraw from the Paris Agreement in May 2017. According to The Guardian, Paul has received over $250,000 from oil, gas and coal interests since 2012. In July, Rand Paul joined Reps. Justin Amash (R-MI), Thomas Massie (R-KY), John Duncan Jr. (R-TN) and Sen. Bernie Sanders (I-VT) in opposing a bill that would impose new economic sanctions against Russia, Iran, and North Korea. President Trump opposed the bill, pointing out that relations with Russia were already "at an all-time and dangerous low". He did, however, sign the bill though likely out of political pressure.
Paul confirmed in an October 2017 interview he would not vote for the Republican budget in the Senate unless billions in spending were removed from the plan: "If leadership is unwilling to compromise with somebody who is concerned about the debt, then they deserve to lose."
In February 2018, Republican senators introduced an immigration framework akin to that proposed by President Trump and with his support that called for $25 billion being provided for border security in exchange for a pathway to citizenship for 1.8 million immigrants brought into the US illegally. Paul was one of fourteen Republican senators to vote against the proposal.
FiveThirtyEight, which tracks congressional votes, found that Paul had voted with Donald Trump's positions the least out of all Republicans, only voting with him 74% of the time by August 2018. In December 2018, in the wake of court filings implicating President Trump's involvement in campaign finance violations, including an attempt to buy a woman's silence, Paul played down the alleged violations and said that they should not be "over-criminalized." Paul said that the campaign finance violations were "an error in filing paperwork or not categorizing" and that going after such violations would turn the U.S. into a "banana republic, where every president gets prosecuted and every president gets thrown in jail when they're done with office."
Paul introduced a bill on January 25, 2017, that sought to replace the Affordable Care Act which included each person's having a tax credit of $5,000 and not requiring everyone to have coverage, unlike Obamacare.
On March 2, after marching to the House of Representatives side of Capitol Hill, Paul was filmed knocking on a door while demanding to see their copy of the replacing and repealing the Affordable Care Act bill. Paul spoke with President Trump over the phone on March 6, Paul telling him that the repeal and replacement of the Affordable Care Act should be two separate bills. Two days later, Paul said Republicans were united in repealing the Affordable Care Act but divided in their stances on its replacement. On March 12, Paul accused House Speaker Paul Ryan of being misleading in portraying supporters of the American Health Care Act of 2017 as not being negotiable, and three days later, March 15, furthered that Ryan was "selling" President Trump "a bill of goods" that he had not explained fully to the president.
After the bill was pulled by Republican leaders from a vote, Paul released a statement on March 24 thanking House conservatives for rebelling "against ObamaCare Lite." Later, on April 2, Paul golfed with Trump and Budget Director Mick Mulvaney at the Trump National Golf Club in Virginia, where they discussed a variety of topics, including healthcare.
Paul told reporters on June 15 that he was willing to vote for a partial repeal, but not the implementation of new Republican entitlement programs, which he identified as present in both House and Senate versions of the bill. Paul also told reporters on September 11 that he did not believe the Graham-Cassidy bill would pass. Paul tweeted on September 15 that Graham-Cassidy retained "90% of Obamacare" and dubbed it "more Obamacare Lite".
On September 19, Paul asserted the Graham-Cassidy bill as immortalizing the Affordable Care Act and "a big government boondoggle of a trillion dollars of spending" that Republicans should abandon in favor of pursuing measures that would allow for health insurance to be purchased across state lines. On September 22, after President Trump tweeted that "Rand Paul, or whoever votes against Hcare Bill, will forever (future political campaigns) be known as 'the Republican who saved Obamacare'", Paul responded that he would not be coerced into supporting Graham-Cassidy with bribes or bullying.