AAA: Gas prices could rise another 50 cents per gallon this year

Palm Beach County’s average gas price leads Florida at $2.93 per gallon, and a rise of another 50 cents this year is a real possibility, says motorist group AAA, citing partners at the Oil Price Information Service.

“OPIS believes oil prices could reach as high as $90 per barrel before the end of the year,” AAA said in a statement early Monday. “While that high is not guaranteed, gas prices would be 50 cents higher, if it happened.”

Florida gas prices remain at their highest levels in three years, and a full tank costs an average of $42, an increase of $8 from this time last year, AAA said. The per-gallon price is still below a high of $4.08 in 2008, but prices above $3 are already appearing at some local stations and could become the norm as the year progresses.

Heading into the unofficial start of the summer driving season Memorial Day weekend, the average family is expected to pay a total of $200 more for gasoline this summer than last year, and $250 more than in the summer of 2016, the group said. At the same time, U.S. producers are increasing their output, and that’s taking the edge off for now. State and local average gas prices stayed within a penny of where they were a week ago.

Still, gas inventories are dropping as international tensions increase, fueled in part by President Donald Trump’s exit from the Iran nuclear deal, which is expected to result in sanctions that effectively limit the supply of Iranian oil on world markets.

In West Palm Beach, prices on Sunday ranged from $2.70 per gallon at five stations to $3.24 at Texaco on Palm Beach Lakes Boulevard, according to price-tracker GasBuddy.

In Jupiter, the cheapest gas was $2.75 at Mobil on Indiantown Road and Alt. A1A and Circle K on W. Indiantown Road and Orange Road. Four stations tied for the highest at $3.09.

In Wellington, the lowest price was $2.79 at Shell on US 441 near Southern Boulevard and the highest was $3.09 at Shell on Southshore Boulevard, according to GasBuddy.





Gas price hikes easing? Not if Trump exits Iran deal, analysts say

Update: President Trump tweeted Monday, “I will be announcing my decision on the Iran Deal tomorrow from the White House at 2:00 p.m.”

Original post: Retail gas prices sit in a restless and jittery lull as analysts say higher costs at the pump likely await if President Donald Trump pulls out of the Iran nuclear deal by May 12.

Already oil prices have reached a 2018 high, and Friday contracts marked the priciest since November 2014. Generally that means higher costs at the gas station are in the pipeline.

Retail  prices have held steady for a week but “all bets are off right now, pending the President’s decision” on the Iranian nuclear deal, said Mark  Jenkins,  spokesman for motorist organization AAA/The Auto Club Group.

Palm Beach County’s average price fell a penny to $2.85 per gallon as it remained the state’s costliest market, according to AAA. Florida’s average fell one cent to $2.73 on Sunday, but that’s up 35 cents compared to this time last year.

Pulling the U.S. out of the Iran nuclear deal by a May 12 renewal deadline could mean reimposed sanctions against Iran and effectively take 1 million barrels of Iranian oil per day off the world market, resulting in reduced global oil supply and higher fuel prices, AAA said.

In Jupiter, often the priciest town in the priciest market in Florida for gasoline, costs at the pump ranged from $2.67 at a Mobil on Indiantown Rd. and Alt. A1A to $2.99 at Mobil and Shell stations elsewhere on Indiantown Road, according to price-tracker GasBuddy on Sunday.

In West Palm Beach, the low-priced leader was Cumberland Farms, $2.62 on Cresthaven Blvd. near Military Trail, according to GasBuddy.

Obamacare: Trump touts death blow, but Florida sign-ups hit 1.7M

President Donald Trump said removing the penalty for lacking health insurance essentially repeals Obamacare, but sign-ups for 2018 remain close to the same in half the time — and they hit an unexpected 1.7 million in Florida.

Hearing that we matched last year’s total of 1.7 million Floridians is amazing,” said Jodi Ray, project  director for the enrollment-promotion group Covering Florida, on Friday.

Ray said it “proves not just how hard everyone worked to help as many consumers as feasibly possible, but just how great the need is and the personal desire to have health care coverage is to Floridians and Americans across the country.”

And it’s not quite over in the state with the most enrollees  in the federal marketplace. Florida residents can still sign up through Dec. 31, because of an extension related to Hurricane Irma.

The Trump administration cut the enrollment window in half to six weeks and reduced the advertising budget 90 percent. The president said this week he believes the health law is more or less nullified because the tax bill that just became law removes the penalty for not having insurance, which starts at $695.

“When the individual mandate is being repealed, that means Obamacare is repealed,” Trump said Wednesday.

“We didn’t want to bring it up,” Trump said. “I told people specifically be quiet with the fake news media because I don’t want them talking too much about it. Because I didn’t know how people would – but now that it’s approved, I can say the individual mandate on health care, where you had to pay not to have insurance, okay, think of that one. You pay not to have insurance. The individual mandate has been repealed.”

It’s possible that will still have a significant future effect on the Affordable Care Act marketplace. Congressional number-crunchers projected that if fewer healthy people sign up, it could raise premiums for remaining buyers about 10 percent.

Then again, the vast majority of Obamacare’s remaining customers are receiving government subsidies to reduce the cost of insurance — so their out-of-pocket costs change very little despite headline premium increases. Monthly premiums remain under $100 for most in Florida.

So for many, it’s still a better deal than they can find if they are not already covered by an employer’s plan or a government plan like Medicare. The people not getting a good deal are those making too much income to qualify for subsidies.

Nationally, sign-ups stand at about 8.8 million, not far from last  year’s 9.2 million.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said that just proves the Trump administration administered the law more efficiently.

“This year CMS took a more cost effective outreach approach, spending just over $1 per enrollee on outreach and education for Exchange coverage compared to nearly $11 per enrollee last year,” Verma tweeted.

Please, supporters of the Affordable Care Act said. The enrollment numbers came in spite of the administration’s best efforts to kill it, they said.

“There is no reasonable justification for the administration cutting in half the time families had to enroll in coverage and slashing outreach to families,” said Frederick Isasi, executive director of  pro-ACA group Families USA.

Despite that, he said, and despite “slashing funding to provide in-person enrollment assistance, redirecting outreach money, shutting down on Sundays, and reducing the advertising budget by a startling 90 percent – families from across the nation overcame the hurdles put in their way and signed up for coverage at an unprecedented pace.”

In fact, his group says consumers set a new record for weekly enrollment Dec. 10 to December 15, when 4.1 million people selected health insurance plans on Previous high: 4 million signing up during the week of Dec. 13 to Dec. 19, 2015.

2018 ACA Marketplace Enrollment
Florida 1.73 million
U.S 8.8 million
Source: Centers for Medicare and Medicaid through Dec. 15; excludes states with their own exchanges like California and New York.

Trump administration ends subsidies to lower consumer health costs

The Trump administration announced at 11:23 p.m. Thursday it will stop paying billions of dollars to hold down health costs for consumers, a move that has helped drive up premium increases on government exchange plans an average of 45 percent in Florida for 2018.

President Donald Trump (Getty Images)

Florida insurers had already priced into 2018 rate increases the possibility the administration would end “cost sharing” payments of $7 billion or more annually, following threats from President Donald Trump to end what he called “bailouts” for insurers.

About 93 percent of Florida’s more than 1 million Affordable  Care Act marketplace customers will see little change in what they pay each month, though those making too much income to qualify for subsidies get no protection from rate hikes.

U.S. Health and Human Services Acting Secretary Eric Hargan and Centers for Medicare & Medicaid Services Administrator Seema Verma released a statement announcing that cost-sharing reduction payments will be discontinued immediately based on a legal opinion from the U.S. Attorney General’s Office.

“It has been clear for many years that Obamacare is bad policy,” the statement said. “It is also bad law. The Obama Administration unfortunately went ahead and made CSR payments to insurance companies after requesting — but never ultimately receiving — an appropriation from Congress as required by law.”

The statement continued, “In 2014, the House of Representatives was forced to sue the previous Administration to stop this unconstitutional executive action. In 2016, a federal court ruled that the Administration had circumvented the appropriations process, and was unlawfully using unappropriated money to fund reimbursements due to insurers.”

After a  legal review,  the statement said, “we believe that the last Administration overstepped the legal boundaries drawn by our Constitution.  Congress has not appropriated money for CSRs, and we will discontinue these payments immediately.”

It’s now up to Congress to decide whether to continue the payments.

In May, New York Attorney General Eric T. Schneiderman and California Attorney General Xavier Becerra, leading a coalition of 18 states, moved to intervene in the House v. Price court case to defend the subsidies. The DC Circuit granted their intervention in August.

“Again and again, President Trump has threatened to cut off these subsidies to undermine our healthcare system and force Congress to the negotiating table,” Schneiderman said in a statement. “That’s unacceptable.”

Schneiderman said he will not allow consumers to be used “as political pawns in his dangerous, partisan campaign to eviscerate the Affordable Care Act at any cost.”

The coalition of states, which does not include Florida, stands “ready to sue if President Trump cuts (subsidies) off,” he said in a statement at 10:20 p.m. Thursday.

Trump order ignites debate: New health choices or destabilizing move?

President Donald Trump today touted an executive order aimed at making it easier for millions to gain access to cheaper health policies, but Florida Democrats called it “sabotage” and a national consumer group blasted it as a move to promote “junk insurance” and destabilize markets.

Trump said “we are moving toward lower costs and more options in the health care market, and taking crucial steps toward saving the American people from the nightmare of Obamacare.”

The executive order bypasses Congress and represents an attempt to guide health policy from the White House.

“While this executive order claims to help improve consumers’ access to affordable care, it would have the exact opposite effect,” said Betsy Imholz, special projects director for Consumers Union. “Allowing insurers to sell substandard association health plans that aren’t required to cover basic services and benefits will further fragment and destabilize the insurance markets as a whole. This action splits the market into two, pitting the healthy against those with preexisting conditions and life-threatening illnesses — but ultimately both groups lose in this new scheme.”

As the Palm Beach Post reported, selling policies across state lines faces certain practical limitations — insurance companies have increasingly narrow networks of health providers set up within each state. That often means plans in one state are not necessarily convenient or attractive to consumers in another.

The order instructs federal agencies to begin making rules to broaden options for small businesses and their employees to join associations that provide health coverage across state lines. Another part calls for rules allowing certain “short-term” health plans to stay in effect longer, and be renewable. A key question in both cases: Whether this lets the plans make an end run around key Obamacare regulations.

The process could take months.

Sen. Rand Paul, R-Ky., said at the White House Thursday, “Today’s a big day. President Trump is doing today what I believe is the biggest free-market reform of health care in a generation.”

It will allow “millions of people to get insurance across state lines at an inexpensive price,” Paul said.

Trump signaled his intentions late last month.

“We believe states are going to have a far bigger issue than insurance companies when it comes to this concept of selling across state lines, as each individual state has its own insurance commission that has a job to protect its own consumers,” Gordon F. Bailey III, vice president of public affairs and community engagement for Jacksonville-based Florida Blue, the state’s largest health insurer, said Sept. 28 in West Palm Beach.

Insurers will do their best to live with whatever the rules are, he said.

“Allowing health plans to offer innovative products and increasing lower cost options for businesses and individuals is not a bad thing,” Audrey S. Brown, president of the Florida Association of Health Plans, said Thursday.

Florida’s Department of Financial Services “will continue to look deeper at the concept of inter-state insurance sales — and its possible impacts on Florida’s policyholders — as the specifics of President Trump’s plan come to light,” said spokeswoman Ashley Carr said then. “Florida has fashioned itself a leader in implementing insurance consumer protections, and we’d look to see that those protections remain in place.”

On Thursday, Consumers Union’s Imholz said, “Expanding the sale of these association health plans means the growth of junk insurance — coverage that may seem affordable to consumers but actually covers very little, potentially leaving them on the hook for huge out-of-pocket costs.”

She continued, “This is yet another action that undermines the good bipartisan efforts in the Senate to actually strengthen and stabilize the health insurance markets. Consumers deserve better. Every public health stakeholder group — from insurers, to providers, hospitals, patient and public interest groups — has warned that this type of action would hurt the markets and consumers. It’s time for regulators to listen and let the Senate finish their work.”

Trump’s move was applauded by Obamacare critics, including Americans for Limited Government president Rick Manning.

“President Trump has wisely asked the Department of Labor to examine the law and body of regulation to determine whether new regulations can be put into effect allowing for the sale of association health plans across state lines,” Manning said. “The vast majority of Obamacare was written by federal bureaucrats interpreting the law via the regulatory process. President Trump’s direction to the Department of Labor will now use that same process, created by Congress, to inject competition into the health care markets. The great news is that this competition promises to allow more Americans more choices at an affordable cost, truly providing affordable health care options, unlike Obamacare.”

A statement from Florida’s Democratic Party said, “Donald Trump’s executive order will continue his sabotage of health insurance markets across the country. Trump has already caused premiums to increase for millions by deliberately creating instability, limiting funding for advertising and cutting the ACA’s open enrollment period.”


States wary on Trump talk of selling health plans across state lines

President Donald Trump’s announced plans to sign an executive order letting consumers buy health policies across state lines sent ripples through the country Thursday, and an official with Florida’s biggest insurer took note of the likely impact in West Palm Beach.

President Donald Trump (Getty images).

“We believe states are going to have a far bigger issue than insurance companies when it comes to this concept of selling across state lines, as each individual state has its own insurance commission that has a job to protect its own consumers,” said Gordon F. Bailey III, vice president of public affairs and community engagement for Jacksonville-based Florida Blue.

Companies will live by whatever rules are set, he said.

Bailey talked about what comes next for health care as the featured speaker at Palm Beach County’s Business Development Board annual luncheon in West Palm Beach Thursday.

The national advocacy group Consumers Union has warned selling across state lines could foster “junk insurance” and a “race to the bottom” for insurers to cluster in the states with the weakest consumer protections. In turn, it could undercut the ability of individual states to set their own rules to protect, say, consumers with prior health problems from being denied coverage or charged more.

Florida’s Department of Financial Services “will continue to look deeper at the concept of inter-state insurance sales — and its possible impacts on Florida’s policyholders — as the specifics of President Trump’s plan come to light,” said spokeswoman Ashley Carr. “Florida has fashioned itself a leader in implementing insurance consumer protections, and we’d look to see that those protections remain in place.”

Florida’s Office of Insurance Regulation said it will “look forward to reviewing the executive order once it is signed.”

Trump signaled his intentions before the order is actually out.

“I’ll probably be signing a very major executive order where people can go out, cross state lines, do lots of things and buy their own health care,” Trump told reporters Wednesday at the White House. “It’s being finished now. It’s going to cover a lot of territory and a lot of people, millions of people.”

Trump mentioned selling across state lines on the campaign trail, and proponents including Kentucky Republican Sen. Rand Paul say it potentially gives consumers more marketplace choices, promotes competition and could lower costs.

But others say how the order is worded is very important, because it could also undermine state-based regulation and represent a way to use one state’s laws to make an end run around another state’s consumer protections.

“We haven’t yet seen the details of any proposed Executive Order and can’t comment until we see the specifics,” said Mike Consedine, CEO of the National Association of Insurance Commissioners. “As a general matter, health insurers already have the ability to sell insurance in multiple states as long as they comply with state consumer protection and licensing laws, which many already do. The NAIC has long been opposed to any attempt to reduce or preempt state authority or weaken consumer protections.”

Insurers already have a limited ability to sell across state lines under current law and waivers to the Affordable Care Act, though as a practical matter it rarely happens because provider networks are usually set up on a state-by-state basis.

Senate Republicans said this week they could not find the votes to pass an overhaul of Obamacare. Trump’s executive order would represent an attempt to take action without waiting for congressional debate and deliberation.




Florida Obamacare hike now 45%, yet most pay same or less, OIR says

The vast majority of more than 1 million Florida Obamacare customers will pay about the same or less in 2018, state regulators said Tuesday, but about 7 percent without government subsidies could pay a whopping 45 percent more.

Insurers more than doubled their 2018 increases filed just a few months earlier, with some citing the administration’s reluctance to continue billions in “cost sharing” money that president Donald Trump has called “bailouts” for insurers.

Most consumers with a benchmark “silver” plan “will not see an out-of-pocket change, as the federal premium subsidy will also increase to absorb this extra cost,” the state’s Office of Insurance Regulation said in a statement.

In fact, a family of four earning $53,000, as well as an individual earning $27,000, may see a slight decrease in their out-of-pocket health insurance premium in 2018, officials said.

Only customers who buy Affordable Care Act marketplace plans and get no government subsidy — fewer than one in 10 in Florida — potentially face the full premium increase. And they will have off-marketplace options that could be significantly less expensive, officials noted.

Florida’s largest health insurer, Jacksonville-based Florida Blue, said it has close to 1 million customers on ACA market plans. About 66,000 of them have silver plans without government subsidies, with about 19,000 of those in South Florida including Palm Beach County. They potentially take the worst hit if premiums go up 38 percent for a Florida Blue plan, or an average of 44.7 percent for a half dozen companies offering plans on the ACA exchange.

Florida Blue officials urged those consumers to check “off-marketplace” plans once the enrollment period begins in November because they might find a significantly better deal.

The big rate increases, still awaiting final federal approval, “will look surprising on the face of it, but in fact most, if they take care to understand their individual situations, should not see a large out-of-pocket change,” said  Penny Shaffer, market president in South Florida for Florida Blue.

Still, the 45 percent jump makes for an eye-grabbing headline, even as GOP Senate leaders concluded once again Tuesday they do not have the votes to repeal or overhaul the law.

“Years before the Trump Administration came to office, Obamacare’s double-digit rate increases and onerous mandates have been squeezing the pocket books of families in Florida,” said U.S. Health and Human Services press secretary Caitlin Oakley. “Under Obamacare, premiums for individual healthcare plans available in Florida surged by more than $2,400. Floridians are once again facing skyrocketing costs and plummeting choices because of Obamacare’s fundamental failures.”

Opponents of the health law make other points: As of March 15, 93 percent Florida residents who bought health insurance on the federally facilitated exchange received a premium tax credit subsidy. That still left about 100,000 Floridians on the exchanges who don’t currently receive any subsidy and thus potentially face the full impact of rate increases.

Then there are the penalties for not having insurance: In 2015, nearly 535,000 Floridians paid $250 million in penalties to the IRS for the right to go without Obamacare.  And approximately three-quarters of Florida’s counties are projected to have two or fewer insurers offering coverage on the exchange during the upcoming plan year.

An average of 45 percent is more than double what Florida insurers were asking for 2018 just months earlier. Why?

Many insurers’ filings now assume the Trump administration cannot be counted on to continue billions of dollars in cost-sharing payments to help consumers reduce co-pays and deductibles. President Trump has called these “bailouts” for insurers. Yet in this case, squeezing the balloon in one place just increases other government subsidies and may actually increase the net amount taxpayers pay for Obamacare in 2018, according to the Kaiser Family Foundation.

The administration is also shortening the sign-up window to six weeks for 2018,  slashing 90 percent of the advertising budget to tell consumers about the marketplace and reducing money for in-person assistance to get coverage. All of that will likely reduce the number of people who enroll and affect the rates of those who do sign up, insurers figure.

Rate increases for 2018

State-approved premium increases for Affordable Care Act marketplace plans. More than 90 percent of Florida consumers will see little difference in what they actually pay each month after government subsidies, though those with government aid could face the brunt of higher prices.

1 Blue Cross & Blue Shield of Florida Inc. 38.1%
2 Celtic Insurance Co.  46.1%
3 Florida Health Care Plan Inc.  26.5%
4 Health First Commercial Plans Inc. 39.3%
5 Health Options Inc.  36.0%
6 Molina Healthcare of Florida Inc.  71.2%

Source: Florida Office of Insurance Regulation


Trump: Enjoy Obamacare after I block billions

President Donald Trump continued a furious tweet storm Monday by again raising the specter he will cut off billions of dollars for the Affordable Care Act, which he said he will teach insurance companies and Congress a lesson.

Trump started the barrage Saturday, days after the Senate failed to pass a repeal and replace bill: “If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!”

Trouble is, the people who will really feel the damage are consumers if Trump or Congress kill “cost sharing” subsidies, The Palm Beach Post reported. A 20 percent premium increase is likely to result if Trump withholds an estimated $10 billion in such subsidies to cover co-pays and deductibles for 2018, the state’s biggest health insurer Florida Blue warned. More than 1 million Floridians get subsidies of various kinds to lower costs.

Florida Democrats have called that “deliberate sabotage.” Who loses? Low-income consumers are cushioned somewhat by other subsidies that adjust, but middle-income people feel the full impact of overall premium increases. And if insurers simply walk away from ACA exchanges, that reduces choice and drives up costs for everyone in the market, analysts say.

If cost-sharing payments disappear, Trump will be responsible for “the destabilization of the marketplace and the deliberate sabotage of our neighbors’ health and financial well-being,” Florida’s Democratic delegation told the president in a June 8 letter. Signing members included U.S. Rep. Lois Frankel, D-West Palm Beach, and Rep. Ted Deutch, D-Boca Raton.

OK, but at least taxpayers save some money, right? Actually, it represents a net increase of $2.3 billion in costs to taxpayers, the Kaiser Family Foundation calculated, because it drives up costs for another form of subsidy to keep premiums affordable, the Post reported.

There is no evidence Trump has been moved by such arguments.

“If ObamaCare is hurting people, & it is, why shouldn’t it hurt the insurance companies & why should Congress not be paying what public pays?” Trump tweeted Monday.

In addition to “cost sharing” subsidies, Trump is believed to be talking about cutting off employer contributions to members of Congress on their own health plans.

As political rhetoric, threatening to yank affordable health insurance from Congress might play reasonably well in some quarters, if not exactly win friends on the Hill. Handing a higher bill to ordinary folks? That may be harder to sell.


Trump promises truly great healthcare if Senate acts

President Trump promised “truly great healthcare” a day ahead of a possible Senate vote  but said “so far Senate Republicans have not done their job in ending the Obamacare nightmare.”

The challenge will be persuading people like a 60-year-old in Palm Beach County making $20,000 a year why it’s great if his net premiums rise 96 percent in 2020, or $910 a year, under the Senate bill, according to a Kaiser Family Foundation analysis.

CBO: Senate health bill still leaves 22 million without insurance

It’s a much easier sell for a 27-year-old making $60,000, who stands to save 34 percent, or $1,190 a year in Palm Beach County, on her premium after health-savings accounts and tax credits under the Senate plan, per the Kaiser analysis.

Trump spoke surrounded by families from states including West Virginia, South Carolina and Illinois he said suffered from rising premiums or doctors disappearing from health plans.

Gov. Scott blasts Obamacare, ups heat on Senate he may try to join

President Donald Trump (Getty images).

Senate leaders have called for a vote to proceed as early as Tuesday, but have struggled to find enough Republican votes for legislation to repeal and replace the Affordable Care Act. It’s not entirely clear what bill or bills will be considered. One measure would repeal Obamacare in two years without a replacement at the ready.

An initial Senate version would have raised Florida premiums on an average of 69 percent, a Kaiser Family Foundation study found. After government subsidies, premiums would double for many consumers between 50 and 64. A subsequent plan would keep some ACA taxes and provide more money to the states to restore some subsidies or address issues like opioid addiction, and consumer effects would vary depending on how states use that money.

Trump says let Obamacare fail as Senate balks — stakes high for Florida

Generally, younger, healthier and higher-income consumers stand to save under Senate legislation while older, sicker and lower-income people stand at risk of paying more. In part that’s because the plan lets insurers charge older people five times more than younger ones, up from three times now. AARP has fought that as an “age tax.”

People who don’t want insurance or think they could not afford it anyway would no longer have to pay a penalty under the Better Care Reconciliation Act. For that and other reasons the Congressional Budget Office projects 22 million fewer people will have insurance by 2026 compared to keeping current law in place.

“If Republicans don’t Repeal and Replace the disastrous ObamaCare, the repercussions will be far greater than any of them understand!” Trump tweeted Sunday.

Vice President Mike Pence said “help is on the way. President Trump hears you.”



Trump tweets: Let Obamacare fail

As support for a Senate health bill collapsed, President Donald Trump tweeted Tuesday he wants to let the Affordable Care Act fail, an act consumer groups warned would trigger a financial, medical and public health crisis for millions in Florida and other states.

“As I have always said, let ObamaCare fail and then come together and do a great healthcare plan,” Trump tweeted. “Stay tuned!”

Talk in the Senate has turned back to simply repealing Obamacare to take effect in two years, buying time to reach agreement on what to put in its place. That’s similar to legislation that passed in 2015 and was vetoed by then-President Barack Obama.

It appeared doubtful by Tuesday afternoon even the repeal plan can get enough votes to pass either. This isn’t 2015 with a sure veto waiting. It’s the majority party’s decision with 2018 elections over the horizon. The Congressional Budget Office forecast the consequences  of repeal with no clear replacement could include the collapse of the individual market, premiums rising and up to 18 million people losing or choosing to drop coverage in one year.

Trump has threatened threatened to withhold billions of dollars that lower consumer costs by calling these as insurer “bailouts,” though they have been part of the ACA marketplace from the start.

“President Trump, from all indications, is ready and willing to allow the continued sabotage of the existing law in order to make his self-fulfilling hope of Obamacare failure a reality,”  advocacy group Florida CHAIN (Community Health Action Information Network) said in a statement.

Another consideration: Jobs. Florida would lose 181,000 jobs by 2019 under repeal, part of 2.6 million nationwide, an analysis by George Washington University’s Milken Institute School of Public Health found.

“This path to repeal is just as dangerous as the Senate’s replacement plan,” said Betsy Imholz, special projects director for Consumers Union. “The uncertainty created by Congress has scared off insurers, hurting the marketplace and consumers in real time. A full repeal of the Affordable Care Act without any replacement plan would trigger a financial, medical, and public health crisis.”

She continued, “By simply repealing the ACA and abdicating their responsibility to consumers, Senators would be causing the same problems they had with their replacement plan — millions uninsured, skyrocketing premiums, market instability and no protections for those with preexisting conditions are only the beginning of these disastrous consequences.”

Florida has plenty at stake. It leads all states using the federal health marketplace with about 1.5 million customers, and has 4 million served by Medicaid. Millions more Floridians in employer plans could also be potentially affected by repealing ACA rules, such as banning insurers from imposing annual and lifetime caps on benefits, requiring essential benefits like emergency, drug and maternity coverage, and other provisions.

Trump said in another tweet, “We were let down by all of the Democrats and a few Republicans. Most Republicans were loyal, terrific & worked really hard. We will return!”