Axios

It's not every day that Senators Susan Collins and Mike Lee have the same opinion on policy, but the Congressional Budget Office estimate on the impact of the House Obamacare repeal and replacement bill made them feel the same way: Concerned.

It's not just them. Most GOP senators asked about the estimate that 24 million people will lose their coverage told reporters they're not finished reading the CBO report. But some had things to say, none of them good.

• Lee: "I have some concerns with the bill. They have not been eliminated by the CBO report."
• Collins: "The topline numbers are alarming on the loss of coverage."
• Sen. Steve Daines: "Better is possible."
• Sen. Ron Johnson: "Interesting, wasn't it?"

What to watch: What happens to the bill in the House. Unless leadership has some magic solution up their sleeves, this bill is very, very unlikely to pass in the Senate, despite the current plan to take the House-passed bill directly to the Senate floor (if and when the bill passes the House). It's even unclear how it will fare with moderates in the House, who don't come back into town until later this week.

The Alliance of Community Health Plans, a trade group representing large not-for-profit health insurance companies and hospital networks such as Kaiser Permanente and UPMC, is not happy about the Congressional Budget Office's score of the Republican Obamacare replacement. The group called the CBO's estimate of 24 million people losing health coverage over 10 years "extremely troubling" and suggested Congress start over.

It's time to take a step back and thoughtfully consider viable alternatives. — Ceci Connolly, CEO of Alliance of Community Health Plans

Many of the companies in the Alliance of Community Health Plans are also members of America's Health Insurance Plans, the country's largest health insurance lobbying group.

The Congressional Budget Office bomb has gone off. Here's what it says about the House Republican Obamacare replacement plan:

• Coverage: 24 million fewer than Obamacare in 10 years (14 million in 2018)
• Savings: $337 billion in deficit reduction over 10 years
• Premiums: 15 to 20 percent higher in 2018-19; 10 percent lower in 10 years

What it means: It's not a surprise that CBO predicted people would lose coverage — most health care experts predicted it, and Republicans have been prepared for it. They've insisted they're not trying to compete with Obamacare, which required people to buy coverage. But today's estimates are worse than expected — the Brookings Institution predicted the number losing coverage would be 15 million over 10 years.

Seven experts responded to a NYT request to predict what the Congressional Budget Office might say about the Republican Obamacare replacement bill in five different areas: long-term costs, how many people will lose health insurance, how much premiums will change, how many people will lose Medicaid coverage, and how employer-based insurance will change.

What stood out to us:

• Most experts surveyed expect premiums to rise under the GOP plan.
• All of the experts who responded think Americans will lose coverage, but the question remains: How many? They also all think Medicaid enrollment will drop, likely due to the fact that the bill cuts federal funding for the program.
• The jury is still out on how the bill will affect the number of Americans who use employer-based insurance. This number is a little bit of a dark horse, since the GOP bill doesn't directly touch employer insurance, but could have big political consequences if it shows this market will be impacted.

Why it matters: Last week the Republicans' plan made it through two committees — but it had no CBO score, and the Republicans are trying to pass the plan through reconciliation, which requires the CBO to say it will save the federal budget at least $2 billion over 10 years. That score is expected to roll out this week, but if long term costs are higher than they are now, not only is that bad, but the bill must also be changed to hit the $2 billion savings target.

The president today held a "listening session" at the White House with people who say they've been hurt by Obamacare. Trump used it as a chance to also talk up the Republican replacement:

You'll see rates go down, down, down and you'll see plans go up, up, up. You'll have a lot of choices. You'll have plans that nobody is even thinking of today.

Why it matters: It shows that Trump is all-in on the theory that a greater variety of health plans will help control premiums — but people are likely to remember it if rates don't actually go down. (Just like Barack Obama never lived down his promise that his law would save families $2,500 a year.)

The nightmare scenario for Obamacare is a meltdown of the individual health insurance market. If health insurers lose confidence as Republicans struggle with their repeal efforts — or because of the turmoil and price hikes that have already been underway — even more could withdraw, leaving Obamacare customers with nowhere to turn to keep their coverage.

Humana has already done this, raising fears that the meltdown could actually happen. But it's always a vague threat, with no real specifics. Katherine Hempstead and her research team at the Robert Wood Johnson Foundation helped Axios map out the likely impact if other insurers that have been on the fence decide to pull out.

Here's what it would look like: If insurers like Anthem decide to exit the exchanges for 2018, hundreds of thousands of people would be stranded without any available insurers. Some state marketplaces would almost certainly fall apart.

The White House and Republican Hill leaders are setting a dauntingly high bar for their plan to replace Obamacare:

• Trump's top economic adviser, Gary Cohn, told Chris Wallace on "Fox News Sunday" that the administration will do "whatever it takes" to get the bill passed.
• When NBC's Chuck Todd asked on "Meet the Press" what success would look like, HHS Secretary Tom Price said it means "more people covered than are covered right now, and at an average cost that is less" (which contradicts the administration's line that coverage is the wrong focus).
• Price also told Chuck that "nobody will be worse off financially."
• Speaker Ryan told John Dickerson on CBS's "Face the Nation" that he agrees with President Trump that the 2018 elections would be a "bloodbath" for Republicans if they fail to pass his Obamacare replacement.

Echoing into the week: On ABC's "This Week," Arkansas Sen. Tom Cotton had this warning for Republican House members: "Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote."

Sen. Tom Cotton warned House Republicans on Sunday that the House Republican Obamacare replacement bill can't pass the Senate as written — and that they could lose the House in next year's elections if they vote for it. "I'm afraid that if they vote for this bill, they're going to put the House majority at risk next year," Cotton said on ABC's "This Week." He warned that it would have "adverse consequences for millions of Americans" and wouldn't lower costs: "Do not walk the plank and vote for a bill that cannot pass the Senate and then have to face the consequences of that vote."

Why it matters: Cotton's warning was even more urgent than his comments last week that the House should slow down. Earlier in the show, Office of Management and Budget director Mick Mulvaney said the speed of the process isn't a problem, because the bill is just "a framework" and Cotton and other senators will have chances to amend it. But Cotton says the bill would require "a lot of carpentry," because it would leave Obamacare's insurance regulations in place, which he says drive up costs.