Senate Republicans’ newest health care bill would cause 32 million additional Americans to become uninsured over the next decade, the Congressional Budget Office projected Thursday.

Republicans on Wednesday put forward the Obamacare Repeal Reconciliation Act, a bill that would wipe the health law’s coverage expansion off the books without a replacement in 2020. The bill comes as the Senate has struggled to agree on what plan should replace the Affordable Care Act. On Monday, Senate Majority Leader Mitch McConnell put forward the idea that the party should vote on a clean repeal bill and set a deadline in the future for creating a replacement plan.

If they didn’t come up with a new plan, the CBO report projects a dire future for the individual health insurance market: Premiums would double by 2026, and three-quarters of Americans would live in areas without any health plans willing to sell coverage.

The CBO expects that the elimination of the health law’s coverage expansion would decrease the federal deficit by $473 billion.

Republicans have described this policy as “repeal and delay,” because the bill would not take effect until 2020. The CBO report suggests this is somewhat of a misnomer. Some of the changes in the ORRA would take effect immediately, and the CBO estimates this would cause 17 million Americans to lose coverage immediately, in 2018.

The newest Senate bill would wreak havoc on the insurance markets

The ORRA does thorough work demolishing Obamacare’s insurance expansion. It eliminates funding for the Medicaid expansion, which extended the government insurance program to millions of low-income adults, as well as the tax credits to purchase health coverage on the individual market.

It would leave millions without health insurance unless Republicans were able to agree on a replacement plan at their two-year deadline.

The ORRA would keep key Obamacare regulations on the books, including the requirement that insurance plans not discriminate against people with preexisting conditions. Republicans cannot repeal these parts of Obamacare because they are using the reconciliation process to pass the bill with a 50-vote majority and avoid a filibuster. But in reconciliation, provisions that are regulatory, with no budgetary impact, are off limits.

The CBO projects that requiring insurers to offer coverage to everyone but not requiring all Americans to purchase coverage would badly damage the individual market. They expect that this bill “would destabilize the non-group market, and the effect would worsen over time.”

Specifically, they expect that 17 million Americans would lose coverage next year, because the individual mandate penalty would be repealed immediately. This number would include some people who legitimately did not want to purchase coverage and only did so because of the federal requirement. But it would also include some people who wanted to buy insurance but whose premiums became unaffordable as healthy people exited the market.

Over time, the Congressional Budget Office expects that health plans would flee the insurance marketplaces. By 2026, three-quarters of the population would live in areas where zero health insurers sold individual plans.

Over time, Medicaid enrollment would fall by 18 million

The ORRA would end the health law’s Medicaid expansion, which extended coverage to millions of low-income Americans, in 2020.

The CBO estimates that this would lead to 18 million fewer Americans having coverage through that public program by 2026.

In total, an estimated 59 million Americans would be expected to have no health coverage within a decade — compared with 28 million under current law.