Huge blow to Republicans' Obamacare replacement

The Congressional Budget Office is out with its much-awaited report on the projected impact of the Republicans' Obamacare replacement, and it's decidedly bad news for the GOP - at least on one very important count.

While some early estimates suggested that six to 15 million could lose their insurance under the GOP's plan - a healthy portion of the 20 million who gained it under Obamacare - the projections are far north of that.

In fact, they suggest that more people would eventually lose their insurance than have gained it.

The CBO says 14 million would lose their insurance in 2018, that 21 million would lose it in 2020 and that 24 million would lose it in 2026.

Then the CBO report includes this line: "In 2026, an estimated 52 million people would be uninsured, compared with 28 million who would lack insurance that year under current law."

Republicans, sensing this day was coming, have spent the better part of the past week arguing that the CBO score doesn't matter, that it's historically been a poor estimate, and even that it's merely a "beauty contest," as House Speaker Paul Ryan put it at the weekend.That's nearly double.

But it's one thing to make that case; it's another to make just about every Republican senator believe it, as Ryan and President Donald Trump need to.

And it's yet another to get sceptical House Republicans to vote for a bill they know could be dead on arrival in the Senate, where Republicans have just 52 votes.

Perhaps the one big saving grace for the GOP in the CBO report is that it says the law will reduce the deficit over the long term - US$337 billion over a decade.

That's no small number. And as Ryan notes in his statement, the report also says premiums will begin to drop in 2020.

"This report confirms that the American Health Care Act will lower premiums and improve access to quality, affordable care," Ryan said.

But in order to reap those benefits, Republicans will confront the very real possibility of more than 20 million people becoming uninsured. And one very important group isn't likely to benefit from those reduced premium costs, according to the report: old people.

"Under the legislation, insurers would be allowed to generally charge five times more for older enrollees than younger ones rather than three times more as under current law, substantially reducing premiums for young adults and substantially raising premiums for older people," it says.

"Substantially raising premiums for older people" - as in, the people who are much more likely to vote. Strike two.

The CBO estimates that the GOP health care bill would reduce the number of employers offering insurance. https://t.co/grj5bS71jP

— NPR (@NPR) March 13, 2017

From here, the goal of Ryan and other GOP leaders is basically to convince already-sceptical Republicans that the big "24 million" figure is pie in the sky - not a real number and nowhere close to where it will be in reality. It simply cannot be.

And Health and Human Services Secretary Tom Price set about that task shortly after the CBO report came out.

"We disagree strenuously with the report that was put out," Price said. "It's virtually impossible to have that number occur. ... It's just not believable."

But there is very, very little margin for error on that front. From the start, four Republican senators said they will not vote for a bill that decreases the insurance rate by millions, and another senator - Dean Heller of Nevada - over the weekend suggested that getting rid of the Medicaid expansion was a non-starter in his state.

Keeping 50 out of 52 senators onboard - when 13 of them were already sceptical, according to the Post's whip count - will be immensely difficult. And that's if the bill can even get out of the House, which is hardly a guarantee at this point.