As Republicans begin steps to repeal the Affordable Care Act, many GOP Congressional members will have to carefully weigh the fact that a great number of their constituents rely on Obamacare for health coverage.
That's particularly true in south Florida, which is home to the eight congressional districts with the highest concentrations of Obamacare enrollees, according to a report Tuesday from the Kaiser Family Foundation. Three of those districts are led by Republicans.
House Republicans also represent 12 of the top 25 districts with the highest Obamacare exchange participation nationwide. In addition to Florida, those representatives are from North Carolina, Georgia and Utah.
That puts some GOP representatives in a risky and difficult position as they consider repealing a law that insures tens of thousands of their constituents.
"This can cause some tension between the desire that they might have to, on the one hand, do what helps their constituents, and on the other hand, do something that has been a pretty longstanding part of Republican ideology and their commitment to overturn Obamacare," said Leighton Ku, Director of George Washington University's Center for Health Policy Research.
And with a Republican-controlled Congress and presidency, lawmakers' votes aren't just symbolic statements anymore. "Now, it becomes real," Ku added.
On the flip side, plenty of House Republicans represent districts with few Obamacare enrollees. Of the 51 districts with 15,000 constituents or less on the exchanges, 36 are represented by the GOP. Those representatives will likely face little voter pressure about protecting the law.
About 6.3 million, or 55%, of Obamacare enrollees live in districts with a Republican representative, compared with the 5.2 million who live in Democrat-led districts, the Kaiser Family Foundation report found. As of March 2016, 11.5 million people participated on the Obamacare exchanges.
Notably, the House of Representatives has a similar makeup to the distribution of people who obtain coverage through Obamacare; Republicans comprise 241, or 55%, of the 435 House seats in this year's new Congress.
Republican lawmakers have begun the process of repealing Obama's signature health reform law, but the party is fractured on how and when to replace it. It's also unclear how many Americans would be covered under any GOP alternative.
A growing number of Republicans in Congress are raising concerns about the political backlash that could follow if the GOP repeals Obamacare without a replacement plan in place.
That backlash might be most severe in the congressional districts with the highest Obamacare enrollment. At number one: Florida's 27th district in south Miami, where about 96,000 people, or 13% of the district, obtain their health coverage on the Obamacare exchange. That district is headed by Republican Ileana Ros-Lehtinen, who has favored Obamacare's repeal and replacement. In 2013, She called the law's implementation "bungled" and "not the answer for America's health care system." Her office did not immediately return a request seeking comment.
Florida's 26th district, led by Rep. Carlos Curbelo, and its 25th district, represented by Mario Diaz-Balart, are also led by Republicans with more than 70,000 estimated people on the exchanges, according to the report.
House Democrats that represent South Florida districts with some of the highest Obamacare enrollments in the country include Rep. Frederica Wilson (24th district), the former chairperson of the Democratic National Party Debbie Wasserman Schultz (23rd district), and Alcee Hastings (20th district).
Florida has the highest number of Obamacare participants of any of the 39 states on the federal exchanges, with more than 1.7 million people enrolled last year. Texas follows close behind Florida, and North Carolina and Georgia also have high numbers of Obamacare participants.