House Republican leaders plunged into damage control mode Monday after a brutal budgetary assessment of their Obamacare replacement threatened to upend Senate GOP support and armed their critics on the left.

Speaker Paul Ryan’s team quickly pinpointed rosier elements of the report by the Congressional Budget Office, from cost savings to lower premiums. But the bottom line — that the number of uninsured Americans would climb by 24 million within a decade — threatened to upend the GOP leadership’s fragile efforts to unite congressional Republicans around the plan.


“Can’t sugarcoat it. Doesn’t look good,” said Sen. Bill Cassidy (R-La.). “The CBO score was, shall we say, an eye-popper.”

Senate Majority Whip John Cornyn of Texas sought to distance the Senate from the House bill, saying “we expect to do better” than the results that CBO showed.

“The House is going to continue to work on the bill to try and build support for it. But until they do, there’s not much for the Senate to do,” Cornyn said. Asked about conservative predictions this bill can’t pass the Senate, he said: “It’s premature to talk about that.”

That’s to say nothing of centrists spooked by the CBO results. Though conservatives have been the most vocally resistant to the plan so far, the new figures underscore the danger that moderate Republicans who hail from states that embraced Obamacare’s massive Medicaid expansion face if they support the bill. This contingent of House Republicans has been mostly muted about the bill so far and has been viewed by leadership allies as likely to fall in line.

The CBO score is a new obstacle for Republicans hoping to coalesce around a health care vision.

“I’m concerned about the Medicaid population. That’s the biggest part of the coverage for Ohio,” said Sen. Rob Portman (R-Ohio), who has emerged as a protector of his state’s decision to expand Medicaid.

Late Monday, one House Republican — Virginia Rep. Rob Wittmann — announced that the would be opposing the health care bill even though he supports repealing Obamacare.

"After reviewing this legislation and receiving the Congressional Budget Office score today, it is clear that this bill is not consistent with the repeal and replace principles for which I stand," he said in a statement. "I do not think this bill will do what is necessary for the short and long-term best interests of Virginians and therefore, I must oppose it."

Portman, a budget wonk who has been wary of the House plan, argued that the CBO didn’t take into account all the flexibility that the House bill would allow for. But he did not sound like he was closer to publicly supporting the proposal.

Democrats, sensing the danger for Republicans, are already threatening to make the eye-popping number of uninsured people a fixture of the health care debate on Capitol Hill. Deep cuts to Medicaid and a spike in premiums for older Americans are also certain to become fodder for critics of the plan. And many of the positive aspects of the report — like an estimated 10 percent decline in premium growth over a decade — were quickly overshadowed by the brutal estimate of the uninsured.

“Every single House Republican owns this catastrophic bill and should be prepared for backlash at the ballot box, particularly given the anticipated loss of coverage for 14 million people as early as next year,” said Democratic Congressional Campaign Committee spokesman Tyler Law.

House leaders, meanwhile, made the case that the budget assessment was good news.

Ryan immediately praised it and said in a statement that it “confirms” that the GOP plan — titled the American Health Care Act — “will lower premiums and improve access to quality, affordable care.”

“If you read this entire report, I’m pretty encouraged by it. It actually exceeded my expectations,” Ryan said Monday evening on Fox News.

A top aide, Brendan Buck, wrote a series of tweets that pointed to more positive aspects of the report. He highlighted an estimated 10 percent reduction in premium growth by 2026, the elimination of Obamacare’s taxes to the tune of $883 billion and the bill’s potential to reduce the deficit.

Rep. Greg Walden (R-Ore.) argued that the CBO’s score was incomplete because it does not include parts of the GOP plan not included in the current repeal bill. Republicans have long said their replacement would take place in three phases: the repeal bill itself, moves by the Health and Human Services Department to deregulate the insurance industry and additional health care bills that would allow people to purchase insurance across state lines.

“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,” Walden said.

President Donald Trump’s top health adviser, Health and Human Services Secretary Tom Price, said administration officials “strenuously disagree” with the report. Republicans have noted that the CBO predicted more people would be covered by Obamacare in its assessment half-decade ago; those forecasts, however, came up short.

But those reassurances appeared to do little to calm senators’ nerves.

“We’ve got work to do here,” said Sen. Cory Gardner (R-Colo.), who had raised concerns about the bill’s effect on Medicaid.

Asked about the 24 million increase in the number of Americans CBO says could be uninsured in 2026, Senate Finance Chairman Orrin Hatch (R-Utah) said: “Naturally, I’m concerned.”

Price will visit with Senate Republicans on Tuesday to explain how the Trump administration can help mitigate the problems some centrists have with the GOP health care plan. But Republican leaders said that in at least one respect, the effort to cobble together a majority to pass the bill got easier: convincing conservatives.

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“The money-saving numbers are pretty strong. And a lot of the opposition seemed to come from people who thought there wasn’t enough reform in terms of spending,” said Sen. Roy Blunt, a former House leader and now No. 5 in Senate leadership. “In terms of coverage, we need to get a better sense of what Health and Human Services can do.”

Still, the Missouri Republican admitted that the CBO number was “troublesome” to the party’s efforts.

Even aspects of the report that Republican leaders praised included potential pitfalls. Though the report found premium growth that would decline on average by 10 percent over the course of a decade, it also emphasized that those reductions would disproportionately benefit younger people, while older Americans could see sharp spikes.

A likely snow day for Congress on Tuesday is all but certain to keep attention trained on the mounting challenges for Republicans working to pass their Obamacare replacement.