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In February 2020, Rand Paul criticized YouTube for removing a video of his floor speech about the impeachment trial of Donald Trump. His speech contained a controversial question for impeachment manager Adam Schiff and counsel for the president: "Are you aware that House Intelligence Committee staffer Shawn Misko had a close relationship with [...] when at the National Security Council together?"

A supporter of the Tea Party movement, Paul has described himself as a "constitutional conservative". He is generally described as a libertarian, a term he both embraced and rejected during his first Senate campaign. He supports term limits, a balanced budget amendment, and the Read the Bills Act, in addition to the widespread reduction of federal spending and taxation. He favors a flat tax rate of 14.5% for individuals and business, while eliminating the FICA payroll taxes, as well as taxes on inheritance, gifts, capital gains, dividends, and interest. Paul has frequently appeared on Infowars with radio show host and right-wing conspiracy theorist Alex Jones. Ideologically, the American Conservative Union has given Paul a lifetime conservative rating of 96% and the Conservative Review gave him a 92% score. As of February, 2020, according to FiveThirtyEight, Paul had voted with President Trump's position on congressional issues 70% of the time. Since the 2016 Republican primary, when Paul was highly critical of Trump, he has "become one of the president’s closest allies despite occasionally voting against Trump's nominees and legislative proposals."

Paul announced on March 22, 2020, that he had tested positive for coronavirus (COVID-19) amid an ongoing pandemic of the disease. He was the first member of the United States Senate to test positive. Paul received bipartisan criticism from his Senate colleagues after it was discovered that he attended Senate lunches and used the Senate gym while awaiting his test results; he defended his actions because he had no symptoms of the illness and believed it was "highly unlikely" he was sick. On April 7, 2020, Paul announced his recovery.

In January 2019, Paul condemned Senator Mitt Romney for writing an editorial criticizing President Trump. Paul said that Romney's criticism of Trump's character was bad for the country and for the Republican Party.

On July 17, 2019, Paul blocked Senator Kirsten Gillibrand's motion for unanimous consent on a bill renewing the September 11th Victim Compensation Fund along with Utah Senator Mike Lee. The fund was estimated to run out by the end of the year; the bill would renew it until the year 2090. Paul argued that he was not blocking the bill, but rather seeking a vote on an amendment that would offset the new spending by other spending cuts due to the deficit. In a segment on Fox News, which went viral, comedian Jon Stewart and 9/11 first responder John Feal rebuked Paul, accusing him of hypocritical "fiscal responsibility virtue signalling", for delaying passage of the bill, while at the same time he voted in favor of the Tax Cuts and Jobs Act of 2017, which increased the deficit. In response, Paul said he has always insisted on "pay-go provisions" for any increase in spending, including for disaster relief funding, and called Stewart uninformed and a part of a "left-wing mob".

In July 2019, Paul was tapped by President Donald Trump as an envoy to Iran in order to repair Iran–United States relations.

On November 4, 2019, Rand Paul called on the media to reveal the secret identity of Trump's Ukraine quid pro quo whistleblower after threatening to reveal the name himself.

In June 2019, Paul criticized the Trump administration for escalating tensions with Iran. Said Paul: "One of the things I like about President Trump is that he said the Iraq War was a mistake. I think an Iran war would be even a bigger mistake than the Iraq War." In January 2020 he criticized the U.S. airstrike on Baghdad International Airport which killed high-level Iranian General Qasem Soleimani. Paul stated that the attack will increase tensions between the two countries.

Boucher was originally charged in Kentucky state court, but was later charged in federal court, where he ultimately pleaded guilty to assaulting a member of Congress. Boucher was sentenced to 30 days in prison, one year of probation, 100 hours of community service, and a $10,000 fine; prosecutors had sought a 21-month term and have appealed the sentence. The state-court charge was dismissed after Boucher pleaded guilty to the federal charge. On January 30, 2019, a jury awarded Paul $582,834 for punitive damages, pain and suffering, and medical expenses; Boucher's attorney indicated he would appeal.

In August 2019, part of Paul's lung required removal as a result of the injuries he suffered during the attack.

In September 2019, the United States Court of Appeals for the Sixth Circuit vacated Boucher's sentence of 30 days, ruling it was unreasonably short, indicating "closer review" was in order, and remanded the case to the lower court for resentencing. An appeal to the Supreme Court was denied.

In February 2018, Republican Senators introduced immigration framework akin to that proposed by President Trump and with his support that called for a 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.

Five ThirtyEight, which tracks Congressional votes, found that Paul has voted with Donald Trump's positions the least out of all Republicans, only voting with him 74% of the time as of 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."

Referring to ISIS, Paul stated: "I personally believe that this group would not be in Iraq and would not be as powerful had we not been supplying their allies in the war [against Syrian Bashar al-Assad's government]." Paul then supported airstrikes against ISIS, but questioned the constitutionality of Obama's unilateral actions without a clear congressional mandate. Paul has stated concerns about arms sent to Syrian rebels that wind up in unfriendly hands. In December 2018 he supported President Trump's decision to pull the US army out from the Syrian Civil war.

Paul, like father, has also been a critic of neoconservatism, and urged Trump to not choose prominent neoconservative Elliott Abrams to serve as Deputy Secretary of State. In April 2018, Paul voted for the confirmation of Mike Pompeo as Secretary of State. Paul had previously insisted that he would not confirm Pompeo, citing Pompeo's hawkish foreign policy beliefs.

Paul is uncertain regarding the causes behind global warming; he believes the scientific opinion on climate change is "not conclusive." Paul said pollution emissions are subject to "onerous regulation." In 2018, Paul called for an investigation of a National Science Foundation grant that went towards educating meteorologists about the science of climate change. Paul said the grant was "not science" but "propagandizing".

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 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 the President to have the United States withdraw from the Paris Agreement in May 2017. According to the Center for Responsive Politics, 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."

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 Capital 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.

On June 12, 2017, U.S. senators reached an agreement on legislation imposing new sanctions on Russia and Iran. The bill was opposed only by Rand Paul and Bernie Sanders. In July 2018, shortly after 12 Russian intelligence officers have been charged with hacking and leaking emails of senior Democrats, he described the Special Counsel investigation into Russian interference in the 2016 election as a "witch hunt on the president". That same month, Paul blocked a Senate resolution that backed the intelligence community's assessment of Russian election interference and called on President Trump to speak with special counsel Robert Mueller. In August 2018 Paul traveled to Moscow and met with several Russian senators, including Sergey Kislyak. In May 2019, Paul opposed the decision of the Senate Intelligence committee, chaired by Republican Senator Richard Burr, to subpoena Donald Trump Jr., a close friend of Paul's, to testify in front of Congress about his involvement with Russians during the 2016 presidential campaign. In July 2018, Paul was among only two Senators to vote against a Senate motion supporting NATO.

On November 3, 2017, Paul was assaulted by a neighbor, Rene Boucher (then aged 59), a retired anesthesiologist. Paul, who is deaf in one ear, was wearing noise-cancelling headphones while mowing his lawn, reportedly enabling Boucher to tackle him without his own approach being noticed.

Paul was a candidate for the Republican nomination at the 2016 U.S. presidential election. He suspended his campaign in February 2016, after finishing in fifth place out of 12 Republican candidates at the Iowa caucuses.

After the death of Antonin Scalia in February 2016, on February 15, Paul indicated that he would oppose any nomination by President Obama to replace the late Supreme Court Justice.

During a press briefing on May 6, 2016, President Obama called on Paul to stop "blocking the implementation of tax treaties that have been pending for years", arguing that they assisted law enforcement in off shore investigations into tax evasion. Paul advocated for the abolition of gun-free zones during a speech to the National Rifle Association on May 20, citing repeated tragedies occurring in these locations. On June 6, Paul spoke of introducing legislation to cease Selective Service, three days after the death of Muhammad Ali, after whom he intended to name the legislation in tribute.

Paul announced the suspension of his presidential campaign on February 3, 2016, shortly after the Iowa caucus, where he finished 5th of the 12 Republicans in the race.

In 2016, Paul was one of the first members of Congress to come out in opposition to United States support for the Saudi Arabian-led intervention in Yemen. In June 2017, Paul tried to block Trump administration's plan to sell more weapons to Saudi Arabia. In April 2018, he again criticized the U.S.-Saudi Arabia alliance, highlighting that "Saudi Arabia has funded radical madrassas, teaching hatred of America throughout the world, and that Saudi Arabia also supplied arms to ISIS in the Syrian civil war." Paul said that U.S.-backed Saudi blockade of Yemen has further aggravated the humanitarian crisis in the country.

In the beginning of 2015, Senator Paul re-introduced the Federal Reserve Transparency Act. Paul also introduced the FAIR Act, or Fifth Amendment Integrity Restoration Act, which would restrict civil forfeiture proceedings. Paul spoke for ten and a half hours on May 20, 2015, in opposition to the reauthorization of Section 215 of the Patriot Act. Sections of the Patriot Act were prevented from being reauthorized on June 1.

Paul began to assemble his campaign team, setting up campaign offices and hiring his campaign manager in the beginning of 2015, fueling speculation that he was preparing to enter the Presidential race. Paul officially announced his presidential candidacy on April 7, 2015. Within a day of his announcement, Paul raised $1 million.

Regarding the recreational legalization of cannabis, Paul says the issue should be left up to the states and that "you ought to be able to pretty much do what you want to do as long as you don't hurt somebody else". Regarding medical use, Paul has endorsed efforts to legalize in Kentucky and introduced the CARERS Act in 2015 to legalize medical cannabis at the federal level. Paul has also supported states' rights-focused cannabis legislation, introducing the Rohrabacher–Farr amendment in 2014, cosponsoring the STATES Act in 2018, and introducing other amendments. Paul introduced the Marijuana Businesses Access to Banking Act in 2015 to allow cannabis businesses increased access to banks. Regarding industrial hemp cultivation, Paul has supported efforts to legalize in Kentucky and at the federal level as well, introducing the Industrial Hemp Farming Act in 2013.

As a critic of warrantless surveillance of Americans, Paul says "the Fourth Amendment is equally as important as the Second Amendment" and has called for conservatives to more strongly defend Fourth Amendment rights. In 2015 Paul spoke for ten and a half hours on the Senate floor against renewing provisions of the PATRIOT Act that he said were unconstitutional. Paul has called Edward Snowden a "whistleblower" and called for Director of National Intelligence James Clapper to resign for "lying" about the phone metadata program that Snowden exposed. He also filed a class action lawsuit against the Obama administration seeking to end the program. Paul gave a speech at the University of California, Berkeley in 2014 titled "The N.S.A. vs. Your Privacy".

On February 2, 2015, Paul generated controversy by suggesting that states should not require parents to vaccinate their children, because parents should have the freedom to make that decision for their children. In an interview with CNBC on February 2, Paul clarified this statement, commenting "I'm not arguing vaccines are a bad idea. I think they are a good thing, but I think the parent should have some input. The state doesn't own your children. Parents own the children, and it is an issue of freedom." On February 3, he posted a photograph to Twitter of himself being vaccinated.

In February 2014, Paul joined the Tea Party-affiliated conservative advocacy group FreedomWorks in filing a class-action lawsuit charging that the federal government's bulk collection of Americans' phone records metadata is a violation of the Fourth Amendment of the U.S. Constitution. Commenting on the lawsuit at a press conference, Paul said, "I'm not against the NSA, I'm not against spying, I'm not against looking at phone records... I just want you to go to a judge, have an individual's name and [get] a warrant. That's what the Fourth Amendment says." He also said there was no evidence the surveillance of phone metadata had stopped terrorism. Critics, including Harvard University law professor Alan Dershowitz and Steven Aftergood, the director of the American Scientists' Project on Government Secrecy, called the lawsuit a political "stunt". Paul's political campaign organization said that the names of members of the public who went to Paul's websites and signed on as potential class-action participants would be available in the organization's database for future campaign use.

In February, Paul was one of two Republicans to vote against extending three key provisions of the USA PATRIOT Act (roving wiretaps, searches of business records, and conducting surveillance of "lone wolves" — individuals not linked to terrorist groups).

In response to political turmoil in Ukraine in early 2014, Paul initially said that the United States should remain mindful of the fact that although the Cold War is over, Russia remains a military power with long-range nuclear missiles. He said that the United States should try to maintain a "respectful relationship with Russia" and avoid taking actions that the Russians might view as a provocation, such as seeking to have Ukraine join NATO or otherwise interfering in Russia's relationship with Ukraine.

Paul played a leading role in blocking a treaty with Switzerland that would enable the IRS to conduct tax evasion probes, arguing that the treaty would infringe upon Americans' privacy. Paul received the 2014 Distinguished Service Award from the Center for the National Interest (formally called the Nixon Center) for his public policy work.

In response to reports that the CIA infiltrated the computers of the Senate Intelligence Committee, Paul called for the firing of CIA Director John O. Brennan. In December 2014, Paul supported the actions to change United States policy towards Cuba and trade with that country taken by the Obama administration.

In a speech at the GOP Freedom Summit in April 2014, Paul insisted that the GOP has to broaden its appeal in order to grow as a party. To do so, he said it cannot be the party of "fat cats, rich people and Wall Street" and that the conservative movement has never been about rich people or privilege, "we are the middle class", he said. Paul also said that conservatives must present a message of justice and concern for the unemployed and be against government surveillance to attract new people to the movement, including the young, Hispanics, and blacks.

During the 2014 election, Paul launched a social media campaign titled "Hillary's Losers" which was meant to highlight many of the Democratic candidates that lost their bids for the U.S. Senate despite endorsements from Hillary Clinton. Clinton was also a candidate for President and eventually won the Democratic Party's nomination, going on to lose to Donald Trump in the general election.

Paul spent his own campaign money in the 2014 legislative elections, helping Republican candidates for the State House in the hopes of flipping the chamber, thus allowing the legislature to pass the bill (Democratic Governor Steve Beshear's veto can be overridden with a simple majority). However, the Democrats retained their 54–46 majority in the State House. Paul has since given his support to the idea that the Kentucky Republican Party could decide to hold a caucus rather than a primary, potentially giving Paul more time to decide whether he should run for U.S. Senator or continue a potential bid for president.

Unlike his more stridently "non-interventionist" father, Paul concedes a role for American armed forces abroad, including permanent foreign military bases. He has said that he blames supporters of the Iraq War and not President Obama for the growth in violence that occurred in 2014, and that the Iraq War "emboldened" Iran. Dick Cheney, John McCain and Rick Perry responded by calling Paul an isolationist, but Paul has pointed to opinion polls of likely GOP primary voters as support for his position. In 2011, shortly after being elected, Paul proposed a budget which specified $542 billion in defense spending. In 2015, he called for a defense budget of $697 billion.

In 2014, Paul argued that the Obama administration and the CDC was downplaying the threat posed by Ebola virus. In 2020, during the coronavirus pandemic, Paul said that stay-at-home orders to halt the spread of coronavirus amounted to "dictatorship".

On March 6–7, 2013, Paul engaged in a filibuster to delay voting on the nomination of John O. Brennan as the Director of the Central Intelligence Agency. Paul questioned the Obama administration's use of drones and the stated legal justification for their potential use within the United States. Paul held the floor for 12 hours and 52 minutes. He ceded to several Republican senators and Democratic senator, Ron Wyden, who generally also questioned drone usage. Paul said his purpose was to challenge drone policy in general and specifically as it related to noncombatants on U.S. soil. He requested a pledge from the Administration that noncombatants would not be targeted on U.S. soil. Attorney General Eric Holder responded that the President is not authorized to deploy extrajudicial punishment without due process, against non-combatant citizens. Paul answered that he was "quite happy" with the response. The filibuster was ended with a cloture vote of 81 to 16, and Brennan was confirmed by the Senate with a vote of 63 to 34.

In March 2013, Paul, with Senators Ted Cruz and Mike Lee, threatened another filibuster, this one opposing any legislative proposals to expand federal gun control measures. The filibuster was attempted on April 11, 2013, but was dismissed by cloture, in a 68–31 vote. Also in March 2013, Paul endorsed fellow Kentucky Republican Senator Mitch McConnell's 2014 re-election campaign. McConnell had previously hired Paul's 2010 campaign manager, Jesse Benton, as his own campaign manager. Paul's endorsement was seen as a major win for McConnell in avoiding a challenge in the Republican primary.

In response to Detroit's declaration of bankruptcy, Paul stated he would not allow the government to attempt to bail out Detroit. In a phone interview with Breitbart News on July 19, 2013, Paul said, "I basically say he is bailing them out over my dead body, because we don't have any money in Washington." Paul said he thought a federal bailout would send the wrong message to other cities with financial problems.

In October 2013, Paul was the subject of some controversy when it was discovered that he had plagiarized from Wikipedia part of a speech in support of Virginia gubernatorial candidate Ken Cuccinelli. Referencing the movie Gattaca, Paul quoted almost verbatim from the Wikipedia article about the film without citing the source. Evidence soon surfaced that Paul had copied sentences in a number of his other speeches nearly verbatim from other authors without giving credit to the original sources, including in the speech he had given as the Tea Party rebuttal to the president's 2013 State of the Union address. In addition, a three-page-long passage of Paul's book Government Bullies was taken directly from an article by the conservative think tank The Heritage Foundation. When it became apparent that Paul's op-ed in The Washington Times on mandatory minimums and related testimony he had given before the Senate Judiciary Committee both contained material that was virtually identical to an article that had been published by another author in The Week a few days earlier, the Washington Times said that the newspaper would no longer publish the weekly column Paul had been contributing to the paper. After a week of almost daily news reports of new allegations of plagiarism, Paul said that he was being held to an "unfair standard", but would restructure his office in order to prevent mistakes in the future, if that would be what it would take "to make people leave me the hell alone."

Paul was considered a potential candidate for the Republican nomination for the Presidency of the United States since at least January 2013. He delivered the Tea Party response to President Barack Obama's State of the Union address on February 13, 2013, while Marco Rubio gave the official Republican response. This prompted some pundits to call that date the start of the 2016 Republican primaries. That year, he spoke at the Conservative Political Action Conference in Washington D.C., where he won the 2016 Presidential straw poll. Paul went on to win the straw poll for the next two years as well, leading to some considering Paul to be a front runner for the nomination, although CPAC attendees are typically considered younger and more libertarian-minded than average Republican voters.

Paul has focused on criminal justice reform as a legislative priority. He introduced the Justice Safety Valve Act in 2013 to provide judges with greater sentencing flexibility, the Civil Rights Voting Restoration Act in 2014 to restore voting rights for non-violent felons, the REDEEM Act in 2014 to allow sealing and expungement for non-violent crimes, the FAIR Act in 2014 to rein in police use of civil asset forfeiture, the RESET Act in 2014 to address the crack sentencing disparity and how drugs are weighed, the Police CAMERA Act in 2015 to increase the use of body cameras by police, the Stop Militarizing Our Law Enforcement Act in 2015 to reduce the use of military equipment by police, the Pretrial Integrity and Safety Act in 2017 to encourage states to reform bail policies, and the Pregnant Women in Custody Act in 2018 to protect the health and safety of pregnant women in prison. Paul says policies such as the war on drugs and mandatory minimum sentencing have particularly harmed minorities.

In June 2012, Paul endorsed Mitt Romney after it became apparent that he would be the Republican nominee for the 2012 presidential election. However, he was later vocal about his disagreements with Romney on a number of policies.

Paul is co-author of a book entitled The Tea Party Goes to Washington (2011) and also the author of Government Bullies: How Everyday Americans Are Being Harassed, Abused, and Imprisoned by the Feds (2012). Paul was included in Time magazine's world's 100 most influential people, for 2013 and 2014. He is also a contributor to Time magazine.

Paul was sworn in on January 5, 2011, along with his father, who was simultaneously in the House of Representatives.

On September 7, Paul called for a vote of no confidence in United States Secretary of the Treasury Timothy Geithner. Later that month, Paul blocked legislation that would strengthen safety rules for oil and gas pipelines, because, he stated, the bill was not strong enough. In October, Paul blocked a bill that would provide $36 million in benefits for elderly and disabled refugees, saying that he was concerned that it could be used to aid domestic terrorists. This was in response to two alleged terrorists who came to the United States through a refugee program and were receiving welfare benefits when they were arrested in 2011 in Paul's hometown of Bowling Green. Paul lifted his hold on the bill after Democratic leaders promised to hold a Congressional hearing into how individuals are selected for refugee status and request an investigation on how the two suspects were admitted in the country through a refugee program.

For the 113th Congress, Paul was added to the Foreign Relations committee and retained his spot on the Health, Education, Labor and Pensions, Homeland Security and Government Affairs, and Small Business committees.

In April 2011, Paul filed to run for re-election to his Senate seat in 2016. Had he become the Republican presidential (or vice-presidential) nominee, state law would prohibit him from simultaneously running for re-election. In March 2014, the Republican-controlled Kentucky Senate passed a bill that would allow Paul to run for both offices, but the Democratic-controlled Kentucky House of Representatives declined to take it up.

The Wall Street Journal reported in 2010 that, although Paul had told a Kentucky television audience as recently as September 2009 that KTU published ratings each year on state legislators' tax positions and that "we've done that for about 15 years", the group had stopped issuing its ratings and report cards after 2002 and had been legally dissolved by the state in 2000 after failing to file registration documents.

In the 2010 general election, Paul faced Kentucky Attorney General Jack Conway. The campaign attracted $8.5 million in contributions from outside groups, of which $6 million was spent to help Paul and $2.5 million to help Conway. This money influx was in addition to the money spent by the candidates themselves: $6 million by Paul and $4.7 million by Conway.

On June 28, 2010, Paul supporters held their first post-primary online fundraising drive, this time promoted as a "money blast".

Paul specializes in cataract and glaucoma surgeries, LASIK procedures, and corneal transplants. As a member of the Bowling Green Noon Lions Club, Paul founded the Southern Kentucky Lions Eye Clinic in 2009 to help provide eye surgery and exams for those who cannot afford to pay. Paul won the Melvin Jones Fellow Award for Dedicated Humanitarian Services from the Lions Club International Foundation for his work establishing the Southern Kentucky Lions Eye Clinic.

At the beginning of 2009, there was movement by political supporters of his father to draft Paul in a bid to replace beleaguered Republican Kentucky senator Jim Bunning. Paul's potential candidacy was discussed in the Los Angeles Times and locally in the Kentucky press. Paul's father said, "Should Senator Bunning decide not to run, I think Rand would make a great U.S. Senator." On April 15, 2009, Paul gave his first political speech as a potential candidate at a Tea Party rally held in his town of Bowling Green, Kentucky, where more than 700 people had gathered in support of the Tea Party movement.The Tea Party Goes to Washington. Nashville: Center Street. 2011.

On May 1, 2009, Paul said that if Bunning, whose fundraising in 2009 matched his poor numbers in opinion polling for the 2010 election, declined to seek a third term, he would almost certainly run in the Republican Party primary to succeed him, and formed an exploratory committee soon after, while still promising to stay out of the race if Bunning ultimately decided to run for reelection. Paul made this announcement on MSNBC's The Rachel Maddow Show, though a Kentucky news site first broke the news.

On July 28, 2009, Bunning announced that he would not run for reelection in the face of insufficient fundraising. The announcement left only Paul and Secretary of State Trey Grayson as the remaining candidates for the Republican nomination, with Paul announcing on August 5, 2009, that he would officially run for the U.S. Senate as a Republican. The announcement was made through a series of national TV events, radio, and other programs, as well as newspapers in Kentucky.

On August 20, 2009, Paul's supporters planned a moneybomb to kick off his campaign. The official campaign took in $433,509 in 24 hours. His website reported that this set a new record in Kentucky's political fundraising history in a 24-hour period. A second "moneybomb" was held on September 23, 2009, to counter a D.C. fundraiser being held for primary opponent Trey Grayson, by 23 Republican United States Senators. The theme was a UFC "fight" between "We the People" and the "D.C. Insiders". Later in the campaign, Paul claimed his pledge to not take money from lobbyists and Senators who had voted for the bailout was only a "primary pledge"; he subsequently held a fundraiser in Washington, D.C., with the same Senators who had been the target of the September 23, 2009, "moneybomb". Paul ended up raising some $3 million during the primary period. Paul's fundraising was aided by his father's network of supporters.

Although Grayson was considered the frontrunner in July 2009, Paul found success characterizing Grayson as a "career politician" and challenging Grayson's conservatism. Paul ran an ad in February that made an issue out of Grayson's September 2008 admission that he voted for Bill Clinton when he was 20 years old. James Dobson, a Christian evangelical figure, endorsed Grayson on April 26 based on the advice of what Dobson described as "senior members of the GOP", but on May 3 the Paul campaign announced that Dobson had changed his endorsement to Paul after Paul and some Paul supporters had lobbied Dobson insisting on Paul's social conservative bona fides.

On social issues, Paul describes himself as "100% pro life", believing that legal personhood begins at fertilization. In 2009, his position was to ban abortion under all circumstances. Since 2010, he has said he would allow for a doctor's discretion in life-threatening cases such as ectopic pregnancies.

Paul spoke on his father's behalf when his father was campaigning for office, including throughout the elder Paul's run in the 2008 presidential election, during which Rand campaigned door-to-door in New Hampshire and spoke in Boston at a fundraising rally for his father on the 234th anniversary of the Boston Tea Party.

Named board members were Paul, his wife, and his father-in-law. The NBO was, itself, never accepted as an accrediting entity by organizations such as the American Board of Medical Specialties, and its certification was considered invalid by many hospitals and insurance companies. Paul let his own ABO certification lapse in 2005, which did not affect his practice in Kentucky; the state does not require board certification. By Paul's estimate, about 50 or 60 doctors were certified by the NBO. The NBO was incorporated in 1999, but Paul allowed it to be dissolved in 2000 when he did not file the required paperwork with the Kentucky Secretary of State's office. He later recreated the board in 2005, but it was again dissolved in 2011.

Paul managed his father's successful 1996 Congressional campaign, in which the elder Paul returned to the House after a twelve-year absence. The elder Paul defeated incumbent Democrat-turned-Republican Greg Laughlin in the Republican primary, despite Laughlin's support from the NRCC and Republican leaders such as Newt Gingrich and George W. Bush.

In 1995, Paul passed the American Board of Ophthalmology (ABO) boards. Prior to this, in 1992, the ABO had changed its certification program, which had previously awarded lifetime certifications, instead requiring doctors to recertify every 10 years. Those who had already been given lifetime certification were allowed to keep it (according to the ABO, they would not legally have been able to rescind these certifications). Shortly after this change, Paul began a campaign to protest it. This effort culminated in 1997 with him creating, "along with 200 other young ophthalmologists", the National Board of Ophthalmology (NBO) to offer an alternative certification system, at a cost substantially lower than that of the ABO. Its certification exam, an open book take-home test, was described by one taker as "probably harder" and "more clinically relevant" than the ABO's exam.

Born in Pittsburgh, Pennsylvania, Paul attended Baylor University and is a graduate of the Duke University School of Medicine. Paul began practicing ophthalmology in 1993 in Bowling Green, Kentucky, and established his own clinic in December 2007. In 2010, Paul entered politics by running for a seat in the United States Senate. A Republican, Paul has described himself as a Constitutional conservative and a supporter of the Tea Party movement.

After completing his residency in ophthalmology, Paul moved to Bowling Green, Kentucky. He has held a state-issued medical license since moving there in 1993. He received his first job from John Downing of Downing McPeak Vision Centers, which brought him to Bowling Green after completing his residency. Paul worked for Downing for about five years before parting ways. Afterwards, he went to work at the Graves Gilbert Clinic, a private medical group in Bowling Green, for 10 years before creating his own practice in a converted one-story house across the street from Downing's office. After his election to the U.S. Senate, he merged his practice with Downing's medical practice. Paul has faced two malpractice lawsuits between 1993 and 2010; he was cleared in one case while the other was settled for $50,000. His medical work has been praised by Downing and he has medical privileges at two Bowling Green hospitals. In April 2020, after recovering from COVID-19, Paul began volunteering at a hospital in Bowling Green, assisting them in their response to the COVID-19 pandemic in Kentucky.

In response to President Bush's breaking his election promise to not raise taxes, Paul founded the North Carolina Taxpayers Union in 1991. In 1994, Paul founded the anti-tax organization Kentucky Taxpayers United (KTU), and was chair of the organization from its inception. He has often cited his involvement with KTU as the foundation of his involvement with state politics. The group examined Kentucky legislators' records on taxation and spending and encouraging politicians to publicly pledge to vote uniformly against tax increases.

Paul is married to Kelley Paul (née Ashby), a freelance writer. They were married on October 20, 1990, and have three sons, William (born 1992), Duncan, and Robert. William and Duncan attended the University of Kentucky, while Robert attended a private school in the Washington, D.C. area. They reside in Bowling Green, Kentucky. They are active members of the Presbyterian church.

While attending Duke University School of Medicine, Paul volunteered for his father's 1988 Libertarian presidential campaign.

Paul was head of the local chapter of the Young Conservatives of Texas during his time at Baylor University. In 1984, Paul took a semester off to aid his father's primary challenge to Republican Senator Phil Gramm.

Paul attended Baylor University from fall 1981 to summer 1984 and was enrolled in the honors program. During the time he spent at Baylor, he was involved in the swim team and the Young Conservatives of Texas and was a member of a secret organization known as The NoZe Brotherhood. He regularly contributed to The Baylor Lariat student newspaper. Paul dropped out of Baylor without completing his baccalaureate degree, when he was accepted into his father's alma mater, the Duke University School of Medicine, which, at the time, did not require an undergraduate degree for admission to its graduate school. He earned an M.D. degree in 1988 and completed his residency in 1993.

When Rand was 13, his father was elected to the United States House of Representatives. That same year, Paul attended the 1976 Republican National Convention, where his father headed Ronald Reagan's Texas delegation. The younger Paul often spent summer vacations interning in his father's congressional office. In his teenage years, Paul studied the Austrian economists that his father respected, as well as the writings of Objectivist philosopher Ayn Rand. Paul went to Brazoswood High School and was on the swimming team and played defensive back on the football team.

The Paul family moved to Lake Jackson, Texas, in 1968, where he was raised and where his father began a medical practice and for an extent of time was the only obstetrician in Brazoria County.

Paul's campaign got off to a rough start after his comments on the Civil Rights Act of 1964 stirred controversy. Paul stated that he favored 9 out of 10 titles of the Civil Rights Act of 1964, but that had he been a senator during the 1960s, he would have raised some questions on the constitutionality of Title II of the Act. Paul said that he abhors racism, and that he would have marched with Martin Luther King Jr. to repeal Jim Crow laws. He later released a statement declaring that he would have voted for the Act and stated "unequivocally ... that I will not support any efforts to repeal the Civil Rights Act of 1964". Later he generated more controversy by characterizing statements made by Obama Administration officials regarding the Deepwater Horizon oil spill cleanup as sounding "un-American".

Randal Howard Paul (born January 7, 1963) is an American politician and physician serving as the junior United States Senator from Kentucky since 2011. He is the son of former U.S. Representative Ron Paul of Texas who was a presidential candidate in 1988, 2008, and 2012.

Randal Howard Paul was born on January 7, 1963, in Pittsburgh, Pennsylvania, to Carol (née Wells) and Ron Paul, who is also a politician and physician. The elder Paul was a U.S. Representative from Texas and ran for President of the United States three times. The middle child of five, his siblings are Ronald "Ronnie" Paul Jr., Lori Paul Pyeatt, Robert Paul, and Joy Paul-LeBlanc.