This was a big problem for Republican leaders in the Senate who were trying to corral votes for their Obamacare replacement bill, the Better Care Reconciliation Act. Analysis of that bill by the nonpartisan Congressional Budget Office found that the legislation would cut Medicaid by $772 billion from the baseline expected under Obamacare over the next decade, dropping 14 million people from coverage. Senators balked at those numbers.

When that bill collapsed this week, Senate Majority Leader Mitch McConnell (R-Ky.) proposed a replacement: The Obamacare Repeal Reconciliation Act, which would essentially repeal Obamacare without offering a replacement plan. One would think that such a proposal, completely gutting the Medicaid expansion included in Obamacare, would have much more significant effects on the program. But it’s not that simple.

The CBO’s assessment of ORRA that was released Wednesday did estimate that Medicaid spending would be cut by a total of $842 billion by 2026, dropping 18 million people from coverage. But interestingly, the annual spending on Medicaid would actually be higher under the repeal-only bill than the Senate replacement plan by the time a decade had passed.

Over the short term, the cuts to Medicaid are steeper. But since the BCRA changes how Medicaid spending is allocated, by 2026 the projected cuts to Medicaid under the replacement bill would be $158 billion compared with $144 billion under straight repeal.

That’s significant, because the Senate replacement bill actually keeps spending flat relative to inflation — problematic for a program that would certainly need to cover more people as the population grew. Under repeal-only, Medicaid spending would still increase relative to inflation after hitting a low in 2020.

Under repeal-only, the number of people dropped from Medicaid relative to Obamacare would essentially stop after 2021, increasing by 2 million over the next five years. Under the replacement bill, Medicaid would keep shedding enrollees, losing 5 million from 2021 to 2026.