Reform opponents among most needy

A new study points to a political paradox in the long, wrenching debate over revamping the healthcare system: Some members of Congress whose constituents stand to gain the most are nonetheless opposing the bill, while others whose constituents will likely pay more for little reward are some of its most ardent supporters.

The study by the Urban Institute identified 20 congressional districts where more than 30% of residents have no health coverage. Eighteen of those districts are in California, Texas or Florida.

In California, the districts with the highest concentrations of uninsured were in Los Angeles and Orange counties, areas heavily populated by immigrants and other low-income groups. Most of those areas are represented by Democrats who support the healthcare proposals, which promise significant new benefits to their constituents.

But in three Florida districts where nearly one-third of the population is uninsured, Republican congressmen have maintained their opposition.

Republican Rep. Mario Diaz-Balart, who represents portions of the southern tip of the state where 31% of residents are uninsured, says that because none of the Democrats’ proposals are expected to cover everybody, many of his constituents would fall between the cracks.

“My constituents, they also understand that they are the ones that get stuck with the bills,” he said.

Democratic Rep. Henry Cuellar, whose Texas border region district ranks 10th on the uninsured list, says he’s not yet ready to throw his support behind his party’s legislation.

Cuellar says he represents many seniors who fear cuts in Medicare will be used to pay for expanding coverage.

In Massachusetts, which has the lowest uninsured rate in the country, Democrats representing the state’s 10 congressional districts are considered guaranteed votes for the final bill, despite the fact that the state’s own version of healthcare reform -- which closely resembles the plans before Congress -- has done little to hold down healthcare costs for middle-class residents.

A federal overhaul that mirrors the Massachusetts approach would probably leave many of these voters’ existing insurance unchanged while adding new taxes to help subsidize the uninsured.

Democratic Rep. Joe Sestak, who represents an affluent Pennsylvania district that includes portions of the Philadelphia suburbs and ranks among the highest insured districts outside of Massachusetts, is one of the members who helped craft the healthcare bills in the House. “Do I have some [constituents] that are really upset and opposed? Yes, I do,” he said.

But Sestak believes his district will benefit in the long run if the country addresses the strains on the healthcare system caused by the costs of the uninsured.

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kgeiger@latimes.com