At the same time, the plan provides a $600 billion tax cut over 10 years for wealthy Americans, because they would no longer be subject to the taxes that pay for the health care subsidies. When the tax cuts for the rich and the spending cuts to Medicaid are combined, they would result in deficit reduction of $337 billion by 2026. That’s a small fraction of the national debt in exchange for an enormous amount of human misery.

Trump administration officials and congressional Republicans knew the C.B.O. report would be devastating, so last week they launched a pre-emptive attack on the agency, disparaging its professionalism and findings. Their insults were an impressive display of staying on message for an administration and party that has descended into infighting over the elements of the repeal plan. This might have been expected. Yet in the past President Trump himself has tweeted C.B.O. findings to attack President Obama on economic growth, tax cuts, employment and other issues.

“We disagree strenuously with the report that was put out,” Health and Human Services Secretary Tom Price said on Monday. “It’s just not believable.”

Well, whether Mr. Price wants to believe it or not, the numbers are the numbers. The C.B.O. has called it as it sees it, and the picture is clear: Trumpcare would throw millions of Americans off their health coverage. And no amount of spin or scorn for the C.B.O. can alter that reality.