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Chris Heydemann and his daughter Mia, who is deaf, signing "I love you." The family receives financial assistance for Mia's many medical bills from Medicaid due to the Affordable Care Act. Congressional Republicans have introduced legislation that would kill the Affordable Care Act.

The number of uninsured Americans would skyrocket by 24 million by 2026 and health insurance premiums would increase as much as 20 percent in 2018 if the Republican health care bill becomes law, the Congressional Budget Office predicted Monday.

That uninsured estimate is far higher than critics estimated after the legislation was unveiled a week ago. The nonpartisan budget office's report had been eagerly awaited amid the political firestorm in Washington caused by the Republican plan.

The ranks of the uninsured would balloon, the budget office said, due to the rollback of certain Medicaid benefits, which expanded under the Affordable Care Act. In addition, some people will choose to go without because of higher premiums and the lack of an individual mandate to buy insurance.

Democrats once again blasted the legislation. "Now we know why Republicans worked so hard to hide the truth about their bill," said Sen. Jeff Merkley, D-Oregon. "This report by the CBO, whose director was handpicked by Donald Trump's own Health and Human Services Secretary, sounds the alarm that life-and-death care is at risk for millions."

Rep. Greg Walden, the Oregon Republican who helped author the legislation, said the budget office's review is somewhat irrelevant as the bill is just one piece of a package.

"The Congressional Budget Office has not yet analyzed our entire proposal to repeal and replace Obamacare, and today's score reflects only a portion of the actions we will take to roll back red tape, free markets and empower consumers," he said.

There was some good news in the report for Walden and President Donald Trump, who backs the Republican bill.

The budget office predicted the plan would cut the federal deficit by $337 billion over time. After initially increasing, premiums could start coming down in 2020, the office projected. It also opined that the Republicans' mix of financial incentives would be enough "to attract a sufficient number of relatively healthy people to stabilize the market."

State regulators hope the budget office is correct. But they worry that the turbulence brought on by the Affordable Care Act will only get worse under the Republican plan.

The budget office projects about 14 million people currently covered could become uninsured as early as 2018 due to higher insurance rates and the end of the individual mandate, the budget office said.

Without the threat of financial penalties on those who choose not to buy insurance, some will gamble and go without, the report said. Others will forgo insurance in response to higher premiums, the report said.

If the young and healthy drop coverage, it could scare off insurers from even participating due to concerns that too many of their customers would be sick and unprofitable.

Oregonians in the individual market have already been hit with repeated double-digit rate increases and dwindling insurance choices as a result of issues with the Affordable Care Act.

State regulators have become all-too-familiar with those problems.

Currently "rates are unaffordable for many people who don't receive subsidies, especially if they're over 50," said Patrick Allen, director of the Oregon Department of Consumer and Business Affairs. "Even for those with subsidies, access to health has become tougher because of high deductibles and co-payments. Rural Oregonians have relatively less choice in terms of insurance companies, and are at risk of having no companies serving them."

"Nothing that I've seen so far in the Republican plan addresses any of these problems," Allen said. "In fact, it makes most of them worse."

While the debate heats up in Washington, Americans who say the Affordable Care Act improved their lives can only wait and hope.

Lisa Heydemann of Wilsonville is the primary caregiver to her 21-year-old daughter, who is deaf, schizophrenic and suffers from Feingold's Syndrome, a rare genetic disorder that can cause intellectual disabilities. It's been an exhausting, lonely and financially debilitating journey.

When Mia was born, Lisa cashed out her retirement savings to cover her medical bills. "It wasn't much, about $25,000," she said. "In two years it was gone."

The Heydemanns' lives improved markedly with the passage of the Affordable Care Act, which liberalized qualifying standards for Medicaid, the federal health care program for the low-income.

Though Lisa and her husband had their own private insurance through his work, Mia qualified for Medicaid due to her disabilities. Previously, Lisa's husband had made too much money.

Medicaid covered psychiatric visits and respite care; it even paid Lisa a small sum as her daughter's caregiver. For a family pushed at times to the financial brink, the federal money gave them some breathing room.

"The Medicaid expansion really helped us," Heydemann said. "It relieved so much stress. I cried when we qualified."

The Republican bill would roll back the Medicaid expansion in 2020.

-- Jeff Manning

503-294-7606, jmanning@oregonian.com