text: The League of Conservation Voters gave Paul a pro-environment voting-record score of 6% for 2011, and 0% for 2009–2010. (The League considers a perfect score of 100% a measure of strong support for environmental protection.) Republicans for Environmental Protection (REP), whose scorecards rate only Republican lawmakers, gave Paul a score of only 5% for 2010, and 2% for 2009–2010, on a 0 – 100% scale in which a perfect score of 100% is considered by REP to be a measure of strong support for environmental protection. Republicans for Environmental Protection rated Paul "Worst in the House" on the environment of all Republican representatives in the 111th Congress (2009–2010).
  Health policy
  Health care costs
  Paul says that contrary to what most Americans believe, access to health care is not a right, but a good whose value should be determined by the free market. In his view, government has no business in the delivery of health care. When government becomes involved, he says, costs rise and quality of care falls.
  Paul calls for the eventual elimination of Medicare (federally funded health care for the elderly and disabled) and Medicaid (health care for the poor, jointly funded by the federal and state governments), and he has been a staunch opponent of the Affordable Care Act health insurance reform law that was enacted in 2010. He says that federally funded healthcare is "unconstitutional" and that the costs of the programs are unsustainable and are bankrupting the government.