click to enlarge Photo by Jeremy Reper

Despite being a fierce critic of the Affordable Care Act, Florida Gov. Rick Scott isn’t saying where he stands on the 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 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.”