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Diagnosis for chaos: Obamacare repeal without alternative.

Florida Gov. Rick Scott is among Republican leaders champing at the bit for President-elect Donald Trump to repeal the Affordable Care Act, President Obama's signature health-care law. "Day one would be nice for me," Scott said Tuesday after meeting with Trump's pick to lead the U.S. Department of Health and Human Services, Republican Congressman Tom Price of Georgia.

Rapid repeal would cap an ideological triumph for Scott, who broke into politics as a fierce critic of Obamacare. But it could turn into a tragedy for more than a million of his constituents.

Florida has more people signed up for private insurance coverage under the ACA marketplace than any other state: at least 1.5 million. Since the marketplace opened in 2013, the percentage of Floridians from 18 to 64 without insurance has dropped from 21.5 percent to 13.2 percent, according to Enroll America, a coalition formed to promote the ACA.

Reducing the cost shift

Florida's uninsured rate would have dropped further, but Scott and state House Republicans refused to support a bipartisan Senate plan in 2015 to use federal funds offered under the ACA to provide private health insurance for some 800,000 working poor Floridians. Thirty-one states, including some led by Republicans, have accepted the federal dollars and expanded coverage to at least 6 million more Americans that way.

Fewer uninsured Americans means fewer showing up at emergency rooms for the most expensive care, unable to pay for it. That reduces the cost shift to taxpayers and hospitals, along with businesses and families who do pay for insurance.

Nationally, some 20 million Americans owe their coverage to Obamacare. The rate of uninsured Americans has dropped below 12 percent, the lowest in decades.

"This is a product that people want and need," Sylvia Burwell, U.S. secretary of health and human resources, told us in a meeting this past week. She was in Orlando to urge enrollment under the ACA by Thursday's deadline for coverage to take effect on Jan. 1. Later, the deadline was extended to Monday to accommodate the strong demand. Burwell said sign-ups nationally were running ahead of last year's pace, despite the president-elect's promises to repeal the law.

'Huge uncertainty'

Since his victory last month, Trump has talked about maintaining Obamacare's guarantee of insurance coverage for Americans with pre-existing conditions. But it's not clear how that provision could be sustained without keeping the one that Republicans love to hate: the requirement that all Americans purchase health insurance. An insurance pool needs enough healthy people paying premiums to help cover the cost of insuring sick people.

Congressional Republicans are considering voting to repeal Obamacare immediately but prolonging its coverage for a transition period while developing a replacement. However, Burwell warned this approach would create "huge uncertainty" for insurers selling individual policies, who could respond by dramatically increasing their premiums or exiting the market, triggering its collapse.

State budget planners also would face uncertainty, not knowing how long they could count on Washington to keep underwriting most of the cost of coverage for millions of low-income Americans. Hospitals wouldn't know how many of their low-income patients would remain insured, and for how long.

If national health-care policy is headed for another overhaul, America would be better served by a deliberate process, not one accelerated by politics.

Obamacare critics have long argued, with some justification, that the law is too expensive and too restrictive, and has failed to put the brakes on rising health-care costs. Now the burden is on them to come up with a better alternative — without jeopardizing coverage for 1.5 million Floridians, and millions more Americans.

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