obamacare – Florida Politics

Florida Democrats call on Rick Scott to stand up to Donald Trump

Gov. Rick Scott is in Washington raising money for his U.S. Senate campaign, and the Florida Democratic Party says now is as good a time as any to confront Donald Trump for his attacks on health care protections for people with pre-existing conditions.

“According to recent estimates, 7,810,300 Floridians have pre-existing conditions. Those are 7,810,300 of your constituents that could lose their health care if Donald Trump (and your own Attorney General, Pam Bondi) have their way. Yet, despite the potential grave consequences of Trump and Bondi’s lawsuit, you haven’t uttered a word explicitly condemning their actions,” the letter says regarding a multistate lawsuit aimed at removing Affordable Care Act rules guaranteeing health care access for people with pre-existing conditions.

The Trump Administration said earlier this month it will not defend the lawsuit in court.

Scott, in a statement from his Senate campaign last week, said that while “Obamacare is a disaster and costs way too much,” he supports the requirement that health insurers not discriminate against people with pre-existing medical conditions.

He’s yet to back up those words with any action, and that hasn’t gone unnoticed by the Florida Democratic Party.

In an email announcing the letter, the FDP said Scott’s behavior was to be expected, considering he “bragged about crafting the GOP’s recent health care bill that would slash coverage for people with pre-existing conditions (while giving himself a tax break).”

The letter continues:

“Simply put, although we Floridians are tired of your empty rhetoric, we’re also used to it. We know that you have a tendency to say and do anything to get elected. However, in a matter as serious as health care, we hope that you can put aside politics and understand that for many, having access to affordable and quality health care is the difference between life and death.

“On Thursday, while you spend the day hobnobbing with donors in Washington, D.C., we request that you stop by to see your ‘close friend’ Donald Trump and tell him to stop his attacks on health care protections for pre-existing conditions. Or better yet, tell him that Florida is withdrawing as a party to the lawsuit that would make protections for pre-existing conditions unconstitutional.”

The letter is FDP’s latest attempt to turn Trump into an anchor around Scott’s neck. The second-term Republican Governor is challenging incumbent Democratic Sen. Bill Nelson in the fall.

Rick Scott rebuts charges that he’d favor removal of pre-existing conditions coverage

In a statement released by his U.S. Senate campaign, Republican Gov. Rick Scott insisted that he continues to support the requirement that health insurers not discriminate against people with pre-existing medical conditions.

The statement puts Scott at odds with the apparent strategy of President Donald Trump, whose Attorney General Jeff Sessions indicated in recent court filings that the U.S. Department of Justice will not defend the pre-existing conditions coverage guaranteed under federal law through the Affordable Care Act, also known as Obamacare.

It also puts Scott at odds with Florida Attorney General Pam Bondi, who added Florida to a list of states suing in that particular federal court case to get the Affordable Care Act, including the pre-existing conditions provisions, overturned.

Last week Scott also stated he supported non-discriminatory coverage for people with pre-existing conditions, but he declined to discuss the lawsuit.

Democrats have been seeking to tie Scott to Trump. The latest attempt being opposition to the pre-existing conditions law, one of the most popular provisions of ObamaCare. But on Monday Scott delivered a statement refuting that he would support efforts to eliminate the provision, charging that Democrats were doing so falsely.

“My position has not changed – I do not agree with efforts to remove pre-existing conditions,” Scott stated in a news release issued Monday by his campaign. “I’ve continued to say that it is important to cover individuals with pre-existing conditions and that every American, including those with pre-existing conditions, should have the ability to buy any kind of insurance they want. Obamacare is a disaster and costs way too much, but keeping pre-existing provisions should be a part of any healthcare reform. I disagree with efforts to dismantle protections for those with pre-existing conditions.”

Earlier this month, Sessions’ Department of Justice signaled that it would not defend the law’s pre-existing conditions provisions, though U.S. Department of Health and Human Services officials have said they consider pre-existing conditions to continue to be official federal policy.

Florida is among the 20 states that brought that lawsuit against Health and Human Services, and Florida continues to be a party seeking to terminate Obamacare through that suit.

Scott’s opponent in Florida’s U.S. Senate race, incumbent Democratic U.S. Sen. Bill Nelson, and all 11 Florida Democrats in Congress sent a letter to Scott last week urging him to withdraw Florida from the lawsuit, and to support pre-existing conditions.

“Having failed multiple times to rip health coverage away through Congress, the Trump Administration is now attempting to use the court system to take the guarantee of health coverage away from 7.8 million Floridians with pre-existing conditions. This is wrong,” The Democrats’ letter states.

Nelson is meeting Monday morning with constituents with pre-existing conditions to talk about the potential policy change.

Scott’s campaign noted that Florida was brought into the federal lawsuit by Bondi who independently has such authority to do so, and was not brought by Scott.

Scott’s campaign also maintains that his position on pre-existing conditions has not changed, that he has consistently supported keeping them in any health care reform. What Scott seeks, the campaign outlined, is: removing Obamacare’s “excessive mandates and taxes;” allowing insurance to be sold across state lines; preserving the provisions requiring pre-existing conditions and that young adults may on their parents’ plans; and allowing families to buy the healthcare they want.

“It looks like Bill Nelson and his Democratic party loyalists new favorite talking point is an attempt to call out Gov. Rick Scott for not taking a position on preexisting conditions, while ignoring clear and documented evidence to the contrary,” Scott’s campaign stated in a news release.

David Bergstein, spokesman for the Democratic Senatorial Campaign Committee, argued that Scott’s long support for repeal of the Affordable Care Act and his support for last year’s Republican health care plan, which would have cut coverage for pre-existing conditions, bely his stated support for the provision.

“Rick Scott cannot escape his record just because it’s deeply unpopular with Florida voters,” Bergstein said in a written statement. “He spent years opposing protections for pre-existing conditions, and then in 2017 he bragged that he actually helped craft the GOP’s health care bill that would slash coverage for pre-existing conditions while giving himself a tax break.”

Rick Scott treads carefully about Obamacare lawsuit

Despite being a fierce critic of the Affordable Care Act, Florida Gov. Rick Scott isn’t saying where he stands on the Donald Trump administration’s refusal to defend the federal law against the latest legal challenge brought by 20 Republican-led states, including Florida.

Scott on Wednesday avoided directly discussing the litigation, which, if successful, could dismantle changes to how insurance is bought and sold in the state, including eliminating protections for people with pre-existing conditions.

“I believe that if you have a pre-existing condition, you need to still be able to get health care. So it’s very important to me,” Scott, who is running for U.S. Senate, said when asked about the litigation. “I believe everybody ought to be able to get health care insurance.”

Scott, Florida Attorney General Pam Bondi and other Republican leaders have consistently opposed the sweeping health care law — often referred to as Obamacare — that has helped lower the percentage of uninsured citizens in the state and nation.

Florida’s uninsured rate in 2013, the year before Obamacare plans became available, was 20 percent and one of the highest in the nation. In 2016, the rate was 12.5 percent.

Florida also has consistently led the nation in the number of people who enroll in the federal health-insurance exchange under the law. Last year, more than 1.7 million Floridians entered the marketplace to buy a plan. The vast majority, more than 90 percent, received federal financial help to reduce their monthly premiums.

Longtime Florida Republican political consultant Mac Stipanovich said Scott is carefully choosing his positions so he doesn’t alienate Trump supporters while trying to defeat Democratic U.S. Sen. Bill Nelson in the fall.

“You have to be careful about criticizing Trump if you want to continue to enjoy the unreserved support from the Trump base,” Stipanovich told The News Service of Florida.

Bondi signed on this year to the lawsuit challenging the Affordable Care Act. The litigation gained new urgency last week after the Trump administration said it would not defend key portions of the law.

Whitney Ray, a spokesman for Bondi, said the attorney general believes people with pre-existing conditions should have access to coverage.

“But Congress must act in accordance with the U.S. Constitution when addressing the issue,” Ray said in a written statement.

If the suit is successful, it would do away with key parts of the law that require insurance companies to sell health policies to people regardless of pre-existing conditions and prevents charging more because of the conditions. The provisions benefit people who aren’t covered by employer-based plans or Medicaid.

Except for a brief period when Scott supported an expansion of Medicaid, Stipanovich said the governor “has been consistently opposed” to the Affordable Care Act or policies like it.

“I think that is something he cannot deny. And I’m not sure he would deny. Whether it turns out to be important in November or not as opposed to offshore drilling or gun control or immigration is a totally different issue,” Stipanovich said.

Florida Democrats are aggressively trying to make Scott’s opposition to the Affordable Care Act an issue. Democrats in the state’s congressional delegation sent a letter Wednesday to Scott calling on the state to immediately withdraw from the lawsuit, which is led by Texas.

“If successful, this dangerous lawsuit that you and Attorney General Bondi have joined will harm roughly 130 million Americans, including 7.8 million Floridians, who have a pre-existing condition,” the Democratic lawmakers wrote. “And it will take us back to a time when health insurers oftentimes outright rejected, or offered severely limited coverage to, Americans with such conditions.”

Democrats also have launched what they are calling “The Time is Now: Medicaid Expansion Tour” to promote Medicaid expansion in the state. The tour, which started in Gainesville, will highlight how Scott flipped his position on Medicaid.

Scott initially ran for governor in 2010 on an anti-Obamacare platform but said in 2013 he supported a three-year Medicaid expansion and described it as a “compassionate, common-sense step forward.”

During his campaign for re-election in 2014, Scott reiterated his support for the expansion, which was available to all states under the Affordable Care Act. After getting re-elected, though, Scott reversed his position and adamantly fought against efforts by the Florida Senate to expand Medicaid in 2015. The proposed expansion died in the Legislature.

A group called Floridians for a Fair Shake, held a press conference this week to highlight the litigation against the Affordable Care Act because of the potential impact it would have on people with pre-existing conditions. Stephen Gaskill, the group’s communications director, called pre-existing condition protections the most “compelling part of health care reform overall.”

Prior to the federal law, insurance companies could charge higher premiums based on pre-existing conditions or the use of health care services. The federal law also established adjusted community rating, which barred insurers from raising premiums based on health status, medical claims or gender, among other things.

While Scott did not directly address the Trump administration’s actions, he briefly outlined changes he thinks could lower health-insurance costs.

Scott said the changes should be incremental but said he supports “allowing more competition (among insurers), we gotta let people buy the insurance that fits for their family and we’ve got to reward people for taking care of themselves.”

Bill Nelson says Rick Scott to blame for ‘Florida health care crisis’

Florida Democratic U.S. Sen. Bill Nelson sat with a room full of public health officials Tuesday morning who declared that Florida is suffering through a crisis of health-care access and he put the blame squarely on his Republican rival in this year’s election, Gov. Rick Scott.

Nelson, holding a roundtable on health care in Orlando Tuesday as part of his re-election campaign, waffled somewhat in talking with reporters earlier about whether the access-to-health-care problems were all Scott’s doing, or shared by him and the Florida Legislature.

But sitting down with public health and mental health services advocates, he pointed to Scott, who in 2015 took a firm stand against Florida accepting the federal offer of $5 billion a year to expand Medicaid to serve people who did not qualify for Medicaid and were too poor to afford health insurance. Scott and the Florida Legislative leaders raised concerns that the long-term costs to Florida might be too high.

Thirty-one other states accepted the Medicaid expansion program, while Florida continues to pass.

“Why didn’t they do it? Well, I’ll tell you exactly why. It was Gov. Scott,” Nelson said.

Estimates on how many Floridians that decision affected by Florida not accepting Medicaid expansion have ranged from 650,000 to over 1 million, with the consensus coming down on 800,000. Those at the table with Nelson Tuesday, including Brendan Ramirez, executive director of Pan American Behavioral Health Services of Florida, and Marni Stahlman, president of Shepherd’s Hope, said that Florida is now in crisis for people needing mental health services, for children without health care, for Puerto Rican migrants who qualified for Medicaid on the island but don’t in Florida, and also for veterans.

Ramirez hosted the round-table discussion at his Medicaid-based mental health center in Orlando. He and others spoke of Orlando being an epicenter for people who cannot afford health care services.

“We have a man-made disaster in this state,” said Candice Crawford, president of the Mental Health Alliance of Central Florida. “I don’t know what the end result is going to be but unless something changes, I’m going to be really, really bad. My last research has 66,000 adults with major mental health issues in this state, without access. Sixty-six thousand adults. Serious mental health issues.”

A new governor would be a good start, Nelson suggested. He said he looks forward to working with whomever succeeds Scott.

The Scott campaign’s Deputy Communications Director Kerri Wyland discountetald any k of crisis, saying the state’s Medicaid program is operating at the “highest level of quality in its history” and that Nelson has done nothing.

“Bill Nelson has had decades of opportunities to take action on healthcare services for Floridians, but instead, he only decides to take up the issue during an election year,” Wyland wrote. “While Nelson continues to be all talk, Florida’s Medicaid program is operating at the highest level of quality in its history and Governor Scott will continue to work toward real solutions for lowering healthcare cost and improving access.”

Nelson had pushed for Florida to accept the Medicaid expansion since it became available through the Affordable Care Act in 2011, and has long been a critic of Florida not accepting it, most recently last week when he took to the Senate floor to criticize the decision. But Nelson generally has been more generic about the target of his ire, blaming the state’s Republican-controlled government. At this event, organized by his re-election campaign, Nelson made it a clear issue with Scott and the election campaign.

Nelson compared Scott’s decision with the governor’s earlier decision to refuse more than $1 billion in federal grants to build the high-speed rail system that once had been planned to connect Orlando and Tampa.

“Gov. Scott said, ‘No, I’m not having anything to do with Obama.’ It was purely partisan, ideological politics,” Nelson said. “So, same thing comes along with the ACA, Obamacare, [and he is] not expanding health care. And by the way, of those 31 states there are a lot of Republican governors and Republican legislatures in those 31 states that expanded it, because they saw the value of poor folks being able to have health care.”

New ad targets Brian Mast’s vote to repeal Obamacare

A new ad by liberal advocacy group “Floridians for a Fair Shake” has taken aim at Republican U.S. Rep. Brian Mast and his vote to repeal the Affordable Care Act.

The ad, titled “Richest,” focuses on the effect the repeal would have had on older Americans, allowing them to be charged up to five times more for health insurance than other age brackets.

Obamacare set a 3:1 limit on the amount Americans over 50 could be charged. The ad also highlights money Mast has taken from insurance and pharmaceutical companies, implying Mast helped them profit by pushing for higher health care costs with his repeal vote.

That vote was ultimately all-for-naught, as the bill to fully repeal Obamacare ultimately failed in the Senate. President Donald Trump and the Republican Congress have sought to undo the ACA in other ways, including repealing the individual mandate in the GOP tax bill passed late last year. But many of the law’s provisions remain intact.

That won’t stop Democrats and liberal groups from targeting Republicans for their vote in the run-up to the midterm elections.

“Congressman Mast talks a good game on health care, but his voting record belies his words,” said Bill Sauers, an advisory committee member of Floridians for a Fair Shake. “We’re exposing his real record — that he’s collecting obscene amounts of cash from the insurance and pharmaceutical industries, and in exchange, they get to gouge aging Floridians.”

Sauers also serves as president of Florida Alliance for Retired Americans.

Mast is an army veteran who is finishing up his first term in Congress representing Florida’s 18th Congressional District. He is facing two challengers in the Republican primary, Dave Cummings and Mark Freeman. On the Democratic side, Lauren Baer and Pam Keith have filed to compete for Mast’s CD 18 seat.

Floridians for a Fair Shake describes its mission as advocating “for an economy that works for everyone and ensuring access to affordable health care for all.” The anti-Mast ad is set to begin its run today in the West Palm Beach-Fort Pierce market, as well as online.

Florida Democrats take aim at GOP on anniversary of Obamacare repeal vote

One year after the House of Representatives voted to repeal Obamacare, Democrats are hoping their base doesn’t forget.

With the 2018 midterms just six months away, the Florida Democratic Party released an ad hammering Republicans on their handling of health care. Though the bill ultimately failed in the Senate, the Democrats still plan to use the repeal attempt to make their case to voters in the upcoming election.

The 21-second digital ad shows a grinning President Donald Trump with a simple scroll of all Florida Republicans who cast a vote to repeal Obamacare. That includes Reps. Carlos Curbelo, Ron DeSantis, Mario Diaz-Balart, Matt Gaetz, and Ted Yoho. The ad wraps up with the hashtag #VoteThemOut.

The ads are set to target the districts of those Republican House members who voted in favor of repeal.

Last year’s repeal vote came just as the Affordable Care Act showed a surge in popularity. The law now has a positive favorability rating according to RealClearPolitics. That’s a shocking turnaround considering the same data showed many more Americans opposing the law in each year from 2010 through 2016.

It’s not clear what caused the law to gain support. But if that support holds, this likely won’t be the last Florida voters hear of the GOP’s efforts to repeal Obamacare.

In addition to the new ad, FDP Chair Terri Rizzo sent out a statement taking particular aim at DeSantis, who’s running to be Florida’s next governor. “Today we are reminded that all  Florida Republican House members voted to take away health care from millions of Americans — including Gubernatorial candidate Ron DeSantis. The steps Republicans have taken to dismantle the Affordable Care Act have already had harsh effects on hard-working Florida families.”

Those steps were all for naught as the bill died on the Senate floor thanks to “no” votes from three Republicans: Alaska Senator Lisa Murkowski, Maine Senator Susan Collins, and perhaps most surprisingly, Arizona Senator John McCain. That left Republicans without a win to tout to their voters, along with what Democrats hope to be a piece of their closing argument come November.

“We are also reminded of the Democratic leaders who fought to protect the Affordable Care Act, like Senator Bill Nelson and all of our Democratic House Members,” said Rizzo. “We will be reminding voters every day until November of who voted to take away their healthcare, who is fighting to protect it, and what is at stake in the 2018 elections.”

Darryl Paulson: The forgotten voices in the opioid debate

Anyone who follows the news knows that opioid abuse and drug deaths are a national problem; 63,000 Americans die of drug overdoses in 2016, an increase of 21 percent over 2015. Opioid deaths in Florida increased to 5,725 in 2016, a 35 percent increase over the previous year.

It is important to remember that opioid abuse covers a range of things, including street drugs and prescription opioids.

Of the 63,000 drug deaths in 2016, most were not related to prescriptions from doctors.

Fentanyl, which attracted national attention due to the death of Michael Jackson, accounted for 19,000 deaths. Most of these deaths came from illegally made pills or powder which was then mixed with heroin or other drugs. Most of the fentanyl was illegally imported from China.

Heroin accounted for 15,500 of the drug deaths. No physician prescribed this for their patients. Pain meds accounted for 14,500 deaths, but less than one-third of opioid abusers got their drugs from a doctor.

Everyone wants to reduce drug deaths, but the legislature must adopt a plan that focuses on the real problem. Most drug deaths do not come from doctor prescribed pain meds, so the plan to attack drug abuse must concentrate on the real source of the problem.

Gov. Rick Scott and the Legislature are focusing on abuse of prescription opioids. This is important, but the Legislature must realize that this is not the primary source of drug abuse. They must also be careful not to impose burdens on Floridians who need the pain meds prescribed by their doctor.

We all want to eliminate illegal drug use and limit the over-prescription of drugs to those suffering from temporary pain. At the same time, we must realize that individuals suffering from a terminal illness, chronic pain or major surgery should not be denied access to pain meds that will allow them to function with minimal pain.

That decision should be made by the doctor, not the Legislature.

It is estimated that 11 percent of Americans suffer from chronic pain. This is a particular problem for the elderly, and Florida has more elderly citizens than any state. I have had chronic pain since age 12. When I was 20, I could no longer sit in my University classes because of the pain.

I was forced to withdraw from classes and had my first major back surgery. My physician wrote the draft board, which had just requested I appear for my physical, that I was unfit to serve due to “chronic discogenic back pain.”

That surgery would be the first of three major back surgeries. I have had seven surgeries total, and five were major surgical procedures. This does not include more than a dozen other medical procedures ranging from numerous epidurals to a procedure where surgeons attempted to thread a wire up my spinal canal. Nor does it count the osteoarthritis that led to a total knee replacement.

I worry about the proposed three and seven-day limits on pain meds. This means that many Floridians will no longer be able to travel to visit friends and family because they won’t be able to get their pain meds. Vacations, especially overseas, will no longer be possible.

Many pain patients are elderly and will have difficulty seeing a doctor every 3 to seven days. Instead of one visit to a pain specialist a month, patients must now visit the doctor as many as 10 times a month. The cost will be prohibitive for many patients. Then imagine the difficulty of going to the pharmacy every three to seven days. Prescription costs will skyrocket.

Many in need of pain meds will likely go days without their meds because of the new guidelines. Withdrawal will happen.

Melissa Sanders-Self, a teacher who suffers from neuroendocrine cancer who must have radiation treatments every three weeks, describes her withdrawal symptoms because she often cannot get the pain meds the doctor has prescribed.

Sanders-Self writes: “Without medicines, I begin to vomit, shake and cry. I cannot concentrate.” Every chronic pain patient can relate to her experiences.

A final issue is that the Legislature is attempting to become the doctor. Remember when Republicans across the nation opposed “Obamacare” because they said it interfered with the doctor/patient relationship. Isn’t that precisely what the Legislature is now doing by dictating what medicines we may have and in what quantity?

We can cut down on illegal drug use, but we must realize that most problems do not come from doctors prescribing pain meds for their patients. The Legislature does have a responsibility to see that Floridians who have documented pain needs can get the medicines they need.

Imposing additional time and financial costs on those who are already suffering from severe medical problems is hardly compassionate.

___

Darryl Paulson is Emeritus Professor of Government at USF St. Petersburg specializing in Florida politics and elections.

HMO group slams bill, likens it to Obamacare

In an attempt to kill a bill that would limit its members from retroactively denying claims, the Florida Association of Health Plans issued a statement Tuesday calling a House proposal (HB 217) “nothing more than a codification” into state law of a federal Obamacare policy.

Filed by Rep. Bill Hager, a Delray Beach Republican, the bill would prevent HMOs and insurance companies from retroactively denying claims after patient eligibility has been confirmed and authorization numbers have been provided.

The limitation on retroactive denials would apply to any group or individual HMO policy issued on or after Jan. 1, 2019. It would not impact Medicaid managed-care plans.

The House Appropriations Committee is slated to take up the bill Wednesday, and the Senate also is poised to pass its version (SB 162), filed by Sen. Greg Steube, a Sarasota Republican.

“This legislation is nothing more than a codification into Florida law of a controversial policy created by the Affordable Care Act,” Audrey Brown, president and CEO of the Florida Association of Health Plans, said in a prepared statement.

The Affordable Care Act, better known as Obamacare, gives insurance customers a three-month grace period before their policies are canceled, so long as the customers previously paid at least one month’s premium. During the first month, the insurer must pay all appropriate claims for services. For the second and third months, insurers can notify health-care providers that payment of claims may be denied.

In her statement, Brown said the bill would allow people who do not pay premiums to game the system and would require health plans and employers to absorb the costs.

The bill has been a priority for the Florida Medical Association and other medical organizations for several years in the Legislature. It generally has been supported by the Senate but has faced an uphill battle in the House.

Report says loss of health care mandate would hit South, Central Florida hard

Three South Florida congressional districts represented by Republicans would be among the hardest-hit in the country according to a new report assessing how many people would lose or drop health care coverage if the final tax reform bill in Congress includes the U.S. Senate’s provision to repeal the individual coverage mandate in Obamacare.

A report “Estimates of the Increase in Uninsured by Congressional District Under the Senate GOP Tax Bill” from the Democratic-leaning Center for American Progress calculated the prospects for people dropping insurance in all 435 U.S. congressional districts, based on numbers produced by the Congressional Budget Office, if the Affordable Care Act’s individual mandate is repealed. The report, first produced earlier this week but revised late Wednesday, found the districts of U.S. Reps. Mario Diaz-Balart, Ileana Ros-Lehtinen and Carlos Curbelo all would be among the top seven in the country in the numbers of people dropping health care coverage.

Districts of Democratic U.S. Rep. Debbie Wasserman Schultz, Val DemingsAlcee HastingsDarren SotoTed Deutch, and Frederica Wilson would not be far behind.

Only one Florida member of Congress, Republican U.S. Rep. Dan Webster, could expect to see his district among the 100 in the nation that are least-affected by projected health care coverage reductions, according to the center. Florida’s 11th Congressional District in west-central Florida could expect to lose 24,100 people from health care coverage, the 18th-least among the nation’s 435 congressional districts.

The fate of the mandate is in the hands of the congressional conference committee, as the tax reform bill approved by the Senate includes the mandate repeal, while the bill approved by the House of Representatives does not.

Overall, Florida could see 873,000 people drop their health care coverage by 2025 if the mandate is eliminated the center estimated, according to the center. Nationally, state-by-state numbers pretty much rank the same as a state’s population size, and Florida would expect to have the third-highest number of people losing or dropping health care coverage, behind the only two states with higher populations, California and Texas.

With congressional districts, however, the variances range more widely, dependent on how many people in each district now are enrolled in Medicaid, or in health insurance policies purchased through the individuals’ market, or in insurance packages purchased through employer-sponsored plans.

The CBO projected that 5 million of those people dropping health care coverage would be dropping from Medicaid, another 5 million from the individuals’ market, and about 3 million from employer-sponsored health insurance.

“Mandate repeal has two effects on the individual market,” Emily Gee, a health economist at the Center for American Progress, explained in her report. “First, some healthy enrollees would drop out of ACA-compliant plans and become uninsured or underinsured. Second, because the remaining enrollees in the risk pool would be sicker on average, insurance companies would need to raise rates about 10 percent to cover the increased average cost. The resulting higher premiums would discourage even more people from obtaining coverage through the individual market.”

With those factors, Diaz-Balart’s district could become one of the most vulnerable in the nation to reductions in health care coverage, a phenomenon expected to not just affect individuals, but also the financial pressures on hospitals, other health care entities, and local governments, the report notes.

The center’s report says that Florida’s 25th Congressional District could expect to see 41,000 people drop or lose insurance, the fourth-highest number of any congressional district. Ros-Lehtinen’s district is projected to lose 40,800, the nation’s sixth-highest total; in Curbelo’s district, 39,900, seventh-highest among the 435 congressional districts, according to the Center for American Progress.

Diaz-Balart’s, Ros-Lehtinen’s, and Curbelo’s offices did not respond Thursday to a request from Florida Politics to comment on the center’s findings.

Several Democrats, already opposed to either version of the tax bill, responded, including Demings, whose 10th Congressional District was projected to lose 37,700 health care enrollees.

“After much debate, the facts are in: the president’s tax bill will raise your healthcare costs, putting your right to manage your own health further out of reach. Without a second thought, donors came first,” she said in a written statement. “The GOP’s proposal would mean nearly a million Floridians would lose their healthcare over the next eight years. Floridians have done their part by turning out in record numbers during the open enrollment period. However, the people seem to have been forgotten in a tax bill that was supposed to be all about the people.”

Soto, whose Florida’s 9th Congressional District in Central Florida is projected to lose about 35,400 enrollees, declared that “Florida’s hardworking families should be troubled by the current GOP Tax bill. As it stands, it is disastrous for our state’s health programs. In Central Florida alone [including his, Demings’ and Democratic U.S. Rep. Stephanie Murphy‘s districts,] approximately 103,000 people would face a reduction in health insurance coverage due to the individual mandate repeal.”

The other four Florida districts projected to be among the nation’s 50 hardest-hit nationally are Wasserman Schultz’s 23rd Congressional District in South Florida (expected to lose 37,700 health care enrollees); Hastings’ 20th Congressional District in South Florida (36,300); and Deutch’s 22nd Congressional District and Wilson’s 24th Congressional District, both in South Florida, both 35,200.

Across the country, the average congressional district would lose about 29,800 enrollees from health care plans, the center reported. Eighteen of Florida’s 27 congressional districts would exceed that average.

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