If the GOP passes legislation to repeal the Affordable Care Act without approving a replacement—and that’s a big if—the plan would have greater negative consequences for consumers than any other plan to overhaul U.S. health insurance proposed by the GOP this year.

Late Wednesday, the Congressional Budget Office (CBO) released a new analysis of a Republican plan to repeal the ACA without an immediate replacement. Under the Obamacare Repeal Reconciliation Act (ORRA), the number of uninsured would grow by 32 million and premiums would double over the next decade, according to the analysis.

By 2026, a total of 59 million people would be uninsured, compared with 28 million if the current law remained in place, leaving 21 percent of the population under 65 without health insurance, according to the CBO analysis.

At the same time, enacting the legislation would decrease the federal deficit by $473 billion in 10 years, according to the CBO score.

After a chaotic week—during which two efforts to vote on legislation to replace or repeal the ACA failed—Senate Republicans aren’t giving up. A number of Senators were meeting Wednesday night to try to salvage efforts to bring legislation to a vote, according to a Politico news report.

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Senate Majority Leader Mitch McConnell, R-Ky., says he wants to hold a vote on the new repeal-only legislation, or replacement legislation if it can be hashed out, next week.

The ORRA is an updated version of a bill Congressional Republicans passed in 2015, which eliminated major portions of the ACA. President Obama vetoed the legislation.

The updated measure would not completely repeal the ACA. It would eliminate the pieces that fall under budget reconciliation rules, including the individual mandate requiring people to buy insurance or pay a penalty and the tax subsidies that help lower income people pay premiums.

It would keep in place a requirement that insurers provide a comprehensive package of 10 essential health benefits and would not allow insurers to deny coverage based on person’s health status or existence of a pre-existing medical condition.

Republicans say changes to the nation's healthcare law are necessary to reduce the price of premiums and to give states the flexibility to offer Americans more affordable healthcare options.  

They say the ACA already is failing because of rising premiums and high out of pocket costs, hurting people who don't qualify for tax subsidies to offset those costs. And they point out that in some counties across the nation few or no options are available as insurers withdraw ACA plans.  

The repeal wouldn’t kick in for two years, but health policy experts and consumer advocates say that it will wreck havoc on the markets in the meantime and would likely spark a collapse of the individual insurance market as insurers run for the exits.

“That doesn’t give Congress much time to implement a replacement,” says Cynthia Cox, an associate director for the program for the study of health reform and private insurance at the Kaiser Family Foundation.

The Impact of A Repeal-Only Plan

Here is how the CBO says a repeal-only plan would affect insurance coverage and costs for consumers:

  • Millions more uninsured people. The number of people uninsured would jump by 17 million in the first year it was implemented. Within 10 years, the number of uninsured would grow by about 32 million. That’s up from the 22 million more uninsured over 10 years projected under the Senate’s earlier plan to replace the ACA, called the Better Care Reconciliation Act, according to the CBO. The repeal plan eliminates the financial subsidies lower-income people get to help pay for premiums, and it also scraps the ACA’s expansion of Medicaid, which helped 14 million people gain insurance. There would be about 23 million fewer people without individual health insurance and 19 million people without coverage under Medicaid.  Those declines would be offset by an increase of about 11 million people covered by employment-based insurance. 
  • Premiums would double. According to CBO, premiums for people who buy on the individual insurance exchanges created by the ACA would rise an average 25 percent in the first year because there would be no penalty for people who don’t buy insurance. The lack of a penalty would likely result in fewer healthy enrollees, leaving insurers to charge more to cover their higher-cost policyholders. Premiums would double in a decade and for people who would no longer get tax subsidies to help pay for premiums, the increase in net premiums would be much greater. 
  • Parts of the U.S. would have no insurer. The prospect of the drop in coverage and the higher-than-expected health care costs for people who remain in ACA plans would drive insurance companies out of the market. According to the CBO, by 2026 a repeal would leave three quarters of the country living in areas where no insurer sells individual health insurance plans, leaving people without Medicaid or employer-insurance with literally no options.