Before they voted to pass the American Health Care Act, House Republicans repeatedly promised the bill would not hurt Americans with preexisting health conditions — that those patients would not lose coverage or pay more for insurance, even though the bill allows states to waive federal regulations meant to protect them.

As House Speaker Paul Ryan put it in late April, “People will be better off with preexisting conditions under our plan.” A couple of days later, President Trump said the bill “guarantees” coverage for those patients. "Preexisting conditions are in the bill,” he told CBS. “And I mandate it.”

The Congressional Budget Office disagrees.

In its analysis of the AHCA published on Wednesday — which Ryan and other Republicans did not wait on before voting on the bill early this month — the CBO devotes a full paragraph to the question of how patients with preexisting conditions would fare in states that chose to opt out of federal regulations on “community rating,” which are the ones meant to protect those patients.

The language is clear (emphasis added):

Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive nongroup health insurance at premiums comparable to those under current law, if they could purchase it at all—despite the additional funding that would be available under H.R. 1628 to help reduce premiums. As a result, the nongroup markets in those states would become unstable for people with higher-than-average expected health care costs. That instability would cause some people who would have been insured in the nongroup market under current law to be uninsured.

The report projects that within 10 years, 23 million fewer Americans would have health care under the bill than under current law. Some of those Americans would be people with preexisting conditions, priced out of their insurance under the new rules of the post-AHCA health landscape. Republicans can challenge that analysis, but they can’t ignore it. It’s not what they said the bill would do.