The Congressional Budget Office (CBO) has released its analysis of the impact of the Senate’s Better Care Reconciliation Act to repeal and replace the Affordable Care Act, concluding that the Senate bill would still result in an additional 22 million Americans becoming uninsured by 2026. If enacted, that impact would be immediate, with 18 million newly uninsured under the bill next year, in 2018. Ten years from now, a total of 49 million, or 17.5% of the U.S. population, would be uninsured.

The CBO analysis estimates that the average cost of health insurance premiums would continue to rise through 2020, only stabilizing after that. Again, the impact of those higher costs would be immediate, with premiums estimated to increase 20% next year, the first year after enactment. At the same time, deductibles would also continue to increase and the “actuarial value” while amount of health care services actually covered by health insurance would decrease. All this means higher costs for less health care.

The CBO does estimate that the ten-year savings from the bill would be $321 billion, greater than the savings projected under H.R. 1628 passed by the House of Representatives in May. There would be $541 billion in tax reductions to the wealthiest Americans, health insurance plans, pharmaceutical and medical device companies. Meanwhile, there would be $772 billion in cuts to the Medicaid program and $408 billion less in tax credits for low-income and middle-income Americans to help them pay for health insurance. The cuts to the Medicaid program would be a cost shift to states, health care providers, and low-income and older Americans who rely on Medicaid for health insurance coverage, including most of the costs of long-term care for older Americans.

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