The American Health Care Act is even worse than Democrats warned from the floor of the House last month when they fell one vote short of blocking Paul Ryan’s bill that was marketed as Obamacare-repeal legislation but was mostly a tax cut for the rich.

The first Congressional Budget Office reports analyzing an early version of the bill estimated that more than 20 million Americans would lose health insurance in the next decade, and premiums would rise 120-125 percent for adults nearing Medicare age. But on Wednesday, the CBO released its analysis of the House-passed bill and found that it would prompt 14 million people to lose their health insurance in 2018 and 23 million within a decade. At the same time, those Americans approaching 65—the age they can obtain health care via government-run Medicare—would face steeper cost increases.

“CBO and JCT [Joint Committee on Taxation] estimate that, in 2018, 14 million more people would be uninsured under H.R. 1628 than under current law,” their analysis said. “The increase in the number of uninsured people relative to the number projected under current law would reach 19 million in 2020 and 23 million in 2026. In 2026, an estimated 51 million people under age 65 would be uninsured, compared with 28 million who would lack insurance that year under current law.”

The non-partisan congressional analysts said that the law would reduce federal health care spending by $1.1 trillion while also being a tax cut of nearly a $1 trillion.

“CBO and JCT estimate that, over the 2017-2026 period, enacting H.R. 1628 would reduce direct spending by $1,111 billion and reduce revenues by $992 billion,” it said. The analysis broke the tax cut down into two large elements, $664 billion for “repeal or delay of taxes on high-income people, fees imposed on manufacturers, and excise taxes enacted under the ACA [Obamacare],” and $210 billion for “collection of penalty payments from employers and uninsured people.”

House Speaker Paul Ryan and House Republicans passed Trumpcare without holding a single hearing and without waiting for an updated CBO score, which was released Wednesday—a day after the White House released its proposed 2018 budget. Together, the Obamacare repeal and the Trump budget would cut federal health care spending by $1.4 trillion—a figure scores of interest groups slammed as deeply cruel and inhumane.

“Today’s CBO score confirms older Americans’ worst fears: the American Health Care Act passed by the House is a disaster for older Americans who are not yet eligible for Medicare,” said Richard Fiesta, executive director of the Alliance for Retired Americans. “The CBO’s numbers are especially troubling for anyone with a pre-existing condition. Premium increases are going to be massive for this group, which includes millions of older Americans. That will destabilize the health care markets. Among people ages 55 to 64, 84 percent had at least one pre-existing condition in 2014.”

“The CBO tells us that at least 23 million people will lose health coverage under the Trump-Republican health plan, including 14 million by next year—most due to $830 billion in Medicaid cuts. On top of that, the president's budget proposes cutting ANOTHER $600 billion dollars from Medicaid, and it slashes Social Security Disability Insurance,” said Frank Clemente, executive director, Americans for Tax Fairness. “So between Trump's health care bill and his budget, Trump is breaking three core promises he made to his supporters over and over again: that he wouldn’t cut Medicaid, that he wouldn’t cut Social Security, and no one would lose their health insurance. Why? So that millionaires, billionaires and corporations can get giant tax cuts.”

“The CBO score proves what we already knew: Trumpcare is a tax cut for millionaires disguised as a health care bill,” said the Patriotic Millionaires’ Sam Quigley. “The supporters of the AHCA have disturbingly misplaced priorities. As wealthy Americans who would prefer living in a healthy society over yet another tax cut for millionaires, the Patriotic Millionaires have spoken out time and time again to say they neither need nor want another tax cut, especially one that comes at the expense of American lives.”

“This bill is nothing short of a disaster,” said Sen. Kamala Harris, D-CA, whose remarks echoed many Democratic members of Congress.”

“This CBO score highlights what we already knew—the AHCA is cruel, deadly and irresponsible,” said Sister Simone Campbell, executive director of Network Lobby for Catholic Social Justice. She urged “each and every Senator to consider the grave effect this loss of coverage would have on our nation. Each one of the 23 million people counted in the CBO estimate is a family member, neighbor and part of a community. Instead of continuing to work on this unconscionable bill, members of Congress should listen to their constituents, read Network's Ten Commandments of Healthcare, and come up with a real solution that expands access to affordable health care.

The CBO score came out the same day Trump and his family were visiting Pope Francis at the Vatican.