Given what has been going on this year there are not the votes for what Rand would consider a replacement. The result of his stance is the status quo with ObamaCare with what appears to be bailouts of the insurance being proposed by Sen Alexander (R-TN). Whether that is right or wrong is a different question.
Right or wrong is the question. Replacing one disaster with another simply to say you did something is not a solution. Two or three years from now you're back where you started from. Paul is preventing them from kicking the can down the road yet again.