WASHINGTON — Florida Reps. Ileana Ros-Lehtinen and Ron DeSantis cut different profiles in the Republican Party, a veteran with moderate leanings and a relative newcomer who is deeply conservative, but together they represent the threat facing the GOP plan to ditch the Affordable Care Act.
Both oppose the legislation, which House Speaker Paul Ryan is pushing through despite growing resistance from factions within the party.
Ros-Lehtinen, of Miami, says the plan goes too far. "Too many of my constituents will lose insurance and there will be less funds to help the poor and elderly with their health care," she said. DeSantis, of Palm Coast, says it doesn't go far enough. "By retaining the core features of Obamacare, the American Health Care Act fails to address the escalating cost of health insurance."
Ryan cannot afford to lose many votes like these, and other Florida Republicans dislike the plan for similar reasons. Still others offer measured support or refuse to comment, a reticence that highlights the challenge of turning a seven-year campaign against Obamacare into reality.
"The framework bill is far from perfect," said Rep. Brian Mast, R-Palm City, who represents a swing district on the east coast and has faced angry constituents at town halls. "The only way we can fix the failures of Obamacare is through a fully transparent process that engages voices all across the country to revise and improve upon this plan."
The stakes escalated this week when the nonpartisan Congressional Budget Office estimated the proposal would result in 14 million fewer people with health care coverage in 2018 and 24 million by 2026. Many would be older Americans as the plan drives up premiums to the point they would drop coverage, no longer facing the Obamacare tax penalty for doing so.
That hits hard in Florida, which has been a leading state for Obamacare, some 1.7 million people, and therefore could experience the biggest rise in the uninsured if the American Health Care Act is adopted, experts say.
More than 90 percent of Floridians with an Obamacare plan in 2016 received government subsidies to lower costs, and more than half had an annual household income that was less than $17,820 for an individual or $30,000 for a family of three.
The GOP plan replaces premium tax credits and subsidies based on age, income and local insurance cost with a flat tax credit based on age. While Obamacare restricted insurers to charging a 64-year-old person three times a 21-year-old, the plan raises the limit to five times.
That 21-year-old would see premiums drop 20 to 25 percent by 2026, but the older person's premium would rise by 20 to 25 percent. Put another way, a young person earning $26,500 a year would pay $1,450 in premiums, down from $1,700 under Obamacare, while an older person with the same income would see rates climb to as much as $14,600 from $1,700 a year, according to the Congressional Budget Office.
"We're one of the oldest states in the country, and you would think the Florida delegation would be very concerned about the impact," said Jeff Johnson, AARP state director. "People think everyone is 85 and playing golf, but Florida has a very large baby boomer population. Some of them still have kids in college. Just about all of them are still in the workforce."
An underlying fear, Johnson said, is older people would postpone treatment until they can enter Medicare at age 65, placing greater burden on that system.
What's more, 4.3 million children, pregnant women, low-income and disabled Floridians would see reductions in Medicaid coverage and access to programs, according to projections. Hospitals with high numbers of uninsured and Medicaid patients would be forced to cut back on services and pass along cost increases to insured patients.
"There are significant consequences for Florida," Steven Ullmann, a University of Miami expert on health policy, told the Miami Herald.
While those concerns are paramount for Ros-Lehtinen, whose district in January had the largest number of Obamacare enrollees in the country, about 96,300, conservatives such as DeSantis think the plan retains too many features of the current system. They view Ryan's plan as "Obamacare Lite."
Against that backdrop, lawmakers are proceeding cautiously.
A number of Florida Republican lawmakers declined to say where they stand on the bill. "Congressman (Matt) Gaetz believes legislation should be read and fully understood. He is actively engaged in that process now," said a spokeswoman for the conservative freshman from Fort Walton Beach.
Gaetz, who upon joining Congress in January declared he had "come to bury Obamacare," is a member of the Budget Committee that will take up the bill today. Four Republican votes against the plan could halt its progress.
Rep. Mario Diaz-Balart, of Miami, who is also on the committee, echoed Ros-Lehtinen on Wednesday, though he did not say he opposed the plan. "I am concerned about the impact this bill could have on low-income and elderly populations," he said.
Some lawmakers are facing campaign-style pressure. Rep. Bill Posey of Rockledge has not said where he stands, but television ads from a group tied to Ryan call on constituents to tell Posey to "vote with President Trump" and support the bill.
The American Action Network has also paid for ads in the district of DeSantis and another conservative, Rep. Ted Yoho, of Gainesville. So far, it hasn't worked. "I would not support it in its present form," Yoho said Tuesday on MSNBC. "But we're working in the right direction. … It's not a finished product."
The group also has placed a TV ad in the Miami district of Rep. Carlos Curbelo, a moderate who last week advanced the bill through the Ways and Means Committee (as did Rep. Vern Buchanan, of Sarasota). The ad drops the Donald Trump mention, and for good reason: Hillary Clinton easily won the district.
Some Republicans are highlighting positive aspects of the plan, including the CBO's estimate it would reduce the budget deficit by $337 billion over a decade. The proposal retains popular Obamacare provisions that protect coverage for people with pre-existing conditions, allow children to stay on their parents' plans until age 26 and eliminate lifetime caps on coverage.
"This legislation is only phase one of three to further lower costs and increase choice for families," said Rep. Dennis Ross, R-Lakeland, who as a deputy whip will face the job of corralling votes. "By repealing and replacing Obamacare, we are keeping our promise to the American people. We are putting patients first."
Rep. Tom Rooney, of Okeechobee, said: "When discussing the CBO's analysis of the impact of the AHCA, it's important to tell the whole story. While CBO did estimate that 14 million more people would be uninsured under the AHCA in 2018, they go on to explain that 'most of that increase would stem from repealing the penalties associated with the individual mandate,' which was Obamacare's plan to make people buy insurance. Obamacare relied on this mandate to help subsidize premiums and inflate the number of people the law covered."
Republican U.S. Sen. Marco Rubio stopped short of endorsing the proposal: "I think the House bill is a work in progress."
There is no ambiguity on where Florida Democrats stand: They are united in opposition.
Information from Miami Herald reporter Daniel Chang was used in this report.