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CBO: 14 million fewer insured by 2018 under GOP health care law

WASHINGTON, DC - MARCH 13: President Donald Trump attends a meeting on healthcare in the Roosevelt Room of the White House on March 13, 2017 in Washington, DC. The House Republicans' bill known as the 'American Health Care Act', which is intended to replace the Affordable Care Act and is endorsed by President Trump, has faced criticism from both Republicans and Democrats. (Photo by Michael Reynolds-Pool/Getty Images)

(CNN) — Fourteen million more Americans would be uninsured under the House Republican health care bill than under Obamacare in 2018, the non-partisan Congressional Budget Office said Monday. That number rises to 21 million in 2020 and 24 million in 2026.

The long-anticipated score immediately puts the writers and supporters of the GOP Obamacare bill on the defensive. It is also certain to complicate the party’s already troubled efforts to repeal and replace the Affordable Care Act.

The Republican bill, titled the American Health Care Act, would reduce the federal deficits by $337 billion over 10 years, the CBO said.

The legislation, introduced last Monday, has sparked deep concern among Republican lawmakers in both the House and the Senate. The sources of unease are wide-ranging.

Prominnent conservatives on Capitol Hill, for example, have argued that the bill doesn’t go far enough, labeling it “Obamacare Lite.” One element of the legislation that has drawn fierce scorn is the refundable tax credits, which conservative Republicans say amounts to an entitlement program.

Moderate Republicans are also uneasy, particularly when it comes to the proposal’s impact on Medicaid expansion. Thirty-one states — including 16 with Republican governors — elected to expand Medicaid under Obamacare and have found it to be a successful way of insuring low-income adults at little cost to their states.

The House GOP bill proposes scrapping the enhanced federal funding for Medicaid expansion in 2020 and overhauls the entire program so that states receive a fixed amount of money per enrollee.

Republicans downplaying the report

In the lead up to the CBO score, Republicans have preemptively downplayed its significance.

“The one thing I’m certain will happen is CBO will say, ‘Well, gosh, not as many people will get coverage.’ You know why? Because this isn’t a government mandate,” House Speaker Paul Ryan said on CBS over the weekend. “So there’s no way we can compete with, on paper, a government mandate with coverage.”

More important than the CBO’s prediction of how many people would be covered under the bill, Ryan added, is the goal of lowering the cost of care by expanding choice and competition.

One House GOP aide put it this way: “They’re saying people are losing coverage but in reality, these people are making a choice,” the aide said. “We’re not ripping coverage away.”

White House spokesman Sean Spicer even went as far as to question the group’s accuracy.

“If you’re looking to the CBO for accuracy, you’re looking in the wrong place,” Spicer told reporters last week.

Republican backers of the bill are also stressing that the CBO score won’t take into account the effects of other healthcare reforms that Republicans hope to enact, including through legislation and administrative actions from Health and Human Services Secretary Tom Price.

One particular promise from Price could soon haunt Republicans.

“I firmly believe that nobody will be worse off financially in the process that we’re going through,” Price said on NBC’s “Meet the Press” Sunday.

Doug Elmendorf, former director of the Congressional Budget Office, said on CNN on Monday that Price’s claim was “absurd.”

“This legislation will cut subsidies substantially; millions of people will lose health insurance,” Elmendorf said. “But certainly people will be worse off.”