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Know where Obamacare repeal will be felt the most? Miami

House Speaker Paul Ryan of Wis., finishes a news conference on Capitol Hill in Washington, Tuesday, Jan. 10, 2017, to discuss efforts to replace the Affordable Care Act, following a closed-door meeting with the GOP caucus.
House Speaker Paul Ryan of Wis., finishes a news conference on Capitol Hill in Washington, Tuesday, Jan. 10, 2017, to discuss efforts to replace the Affordable Care Act, following a closed-door meeting with the GOP caucus. AP

Perhaps nowhere in America would so many people be as personally affected by the Republican-led repeal of Obamacare than Miami.

Three congressional districts – all represented by Republicans – have among the highest number of Affordable Care Act enrollees in the country, offering an irony to those House members’ votes Friday to begin the process of dismantling the 2010 federal law that has extended health insurance to as many as 20 million Americans. Only nine House Republicans, none from Florida, dissented from the near party-line 227-198 vote.

There are 96,300 people enrolled in the Florida district represented by Rep. Ileana Ros-Lehtinen, R-Miami, the highest number in the country, according to estimates by the Kaiser Family Foundation. Her district is followed closely by Rep. Carlos Curbelo, R-Miami, whose southwest Miami-Dade and Monroe County district has 92,500 enrolled in the insurance marketplaces created by the Affordable Care Act.

Rep. Frederica Wilson, D-Miami, who opposes rescinding the law, has the third-greatest number at 94,100, followed by Rep. Mario Diaz-Balart, R-Miami, whose Hialeah to Naples district has 83,300 enrolled.

Ros-Lehtinen acknowledged the incongruity, noting that many in her district are worried about losing what she called the “positive aspects” of President Barack Obama’s signature law, including keeping children on their parents’ insurance through 26 and covering pre-existing conditions.

But Ros-Lehtinen argued that Obamacare – which she has consistently voted to oppose – “has been in an unsustainable downward spiral” since it started. She said the program needs “extensive changes” to sustain it, including eliminating the individual and employer mandates, which Democrats argue are key to expanding care to people who can not afford insurance.

Ros-Lehtinen cited a plan authored by Rep. Pete Sessions, R-Texas, as a potential starting place.

But Democrats warn that Republicans, who have yet to coalesce around a replacement plan for Obamacare, are courting disaster in the insurance markets by looking to take apart the law. Democrats are planning a “Day of Action” on Saturday in various cities to mobilize grassroots opposition to the plan to roll back the act.

“While the Republicans may have an ideological opposition to the Affordable Care Act, they have to understand what it means in cost to their constituents’ cost in benefits, cost in quality of service, cost in access and cost in dollars,” said House Minority Leader Nancy Pelosi, D-Calif. “We’re hoping that they will listen.”

Diaz-Balart, who has also voted repeatedly to repeal the law, said he has been listening to his constituents and hears mostly complaints: Costs are increasing and doctors are increasingly unwilling to accept people with Obamacare, he said.

The deductibles are exceedingly high and then they realize, ‘Hey, this is a bit of a fraud.’

Rep. Mario Diaz-Balart, R-Miami, on the Affordable Care Act

“You know why they come to see me? They come to see me when they have to actually go to a doctor,” Diaz-Balart said. “The deductibles are exceedingly high and then they realize, ‘Hey, this is a bit of a fraud.’”

He said tinkering around the edges, as Democrats have proposed, won’t work: “This concept that bureaucrats in Washington know best for the American people’s health needs, this central planning concept is failing one more time.”

President elect Donald Trump has pressured his Republican colleagues to move quickly on gutting and replacing the law, but Diaz-Balart said he hopes for a legislative process that involves public hearings – something he accuses the Democrats of scuttling in their haste to impose Obamacare.

“It’s going to take awhile, but I want to do it right,” he said. And Republicans are aware of the political pitfalls, he said, contending that Republicans will ensure that current enrollees won’t lose benefits.

Curbelo, who didn’t vote for Trump and whose Democratic-leaning district re-elected him but also went for Hillary Clinton, is similarly nonplussed by the vote.

“We want something better for all of these people,” said Curbelo, adding that his office fields complaints about rising costs and declining choices.

Curbelo was appointed last week to the influential House Ways and Means committee and said he plans to be engaged in writing legislation to replace the health care plan. He expected some replacement provisions could be enacted quickly and that no one would lose coverage because of the Republican repeal.

There is going to a be a transition period. No one is going to be kicked off of any plan by anything we do

Rep. Carlos Curbelo, R-Miami

“This is our opportunity to offer Americans the health care system that we believe they deserve,” Curbelo said.

Freddy Balsera, a Democratic political consultant who is close to Curbelo and supported his candidacy, noted that many in the district viewed Curbelo as a “moderate, willing to work across the aisle.

“He needs to be careful,” Balsera said. “If he votes to end a program that so many thousands in South Florida depend on, he better be quick to offer a solution.”

Tony Pugh of the McClatchy Washington bureau contributed to this report.

Lesley Clark: 202-383-6054, @lesleyclark

The GOP-run Senate on Thursday approved a budget that's seen as the first step toward repealing Obamacare. Sen. Rand Paul of Kentucky was the only Republican to vote “no."

 

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