AP

The latest version of the Republican bill to repeal the Affordable Care Act would leave 23 million more people without insurance within a decade, according to the updated score released on Wednesday by the nonpartisan Congressional Budget Office. Under the American Health Care Act, people with pre-existing conditions could be priced out of the insurance market, and a sixth of the entire population would live in an area where those markets would begin to fall apart by 2020.

The projections are bleak, but responses from the bill’s supporters have been predictably sunny. The White House, same as last time, simply rejected the CBO score as incorrect. (“They are wrong again,” Health and Human Services Secretary Tom Price said Wednesday.)

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House Speaker Paul Ryan, same as last time, opted to focus on the deficit reduction achieved under the bill and ignore the millions of people it would push off their insurance.

But perhaps most perplexing was the reaction from North Carolina Representative Mark Meadows, the chairman of the ultra-conservative Freedom Caucus, and one of two members to introduce an amendment allowing states to opt out of minimum coverage and pre-existing condition requirements.

As the Independent Journal Review first reported, after the CBO numbers came out, Meadows seemed surprised when reporters told him that people with preexisting conditions could be charged more by insurers and potentially priced out of the market entirely.

Here’s the CBO report on the consequences of those waivers:

Community-rated premiums would rise over time, and people who are less healthy (including those with preexisting or newly acquired medical conditions) would ultimately be unable to purchase comprehensive non-group health insurance at premiums comparable to those under current law, if they could purchase it at all — despite the additional funding that would be available under H.R. 1628 to help reduce premiums.”

And here’s Meadows, who reportedly became emotional when discussing the issue:

Listen, I lost my sister to breast cancer. I lost my dad to lung cancer. If anybody is sensitive to preexisting conditions, it’s me. I’m not going to make a political decision today that affects somebody’s sister or father because I wouldn’t do it to myself.

In the end, we’ve got to make sure there’s enough funding there to handle preexisting conditions and drive down premiums. And if we can’t do those three things, then we will have failed.

There’s no reason to doubt the sincerity of Meadows’s emotional response, but there’s good reason to question why he’s surprised by the outcome. There are a lot of people with preexisting conditions in the United States, and the bill he helped craft allows states to opt out of regulations protecting their coverage and underfunds the high-risk pools that are supposed to pick up the slack. It’s pretty straightforward.

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There was also a lot of work put into answering this question before the bill was scored. Earlier this month, the Center for American Progress released its own analysis of the American Health Care Act. Here’s the main point:

The $13 billion per year that the AHCA provides for possible risk pool funding would leave a $20 billion shortfall annually. That gap is too big to be filled in by states, which would already be responsible for contributing to the stability fund.

Meadows’ earlier comment seems to suggest he’s open to increasing funding for high-risk pools, but his office declined Fusion’s request for comment on Wednesday morning. But the shortfall is so great that, by the Center for American Progress’ estimate, in order to match current coverage levels, the new healthcare bill would have to provide $32.7 billion annually.

We’ve already seen what underfunded high-risk pools look like: Waiting lists, premiums that could reach 250 percent the cost of average premiums, and sometimes unmeetable deductibles.

You can either have robust coverage and robust government funding or very little coverage and very little funding. It doesn’t work both ways, and Meadows will have to decide which outcome he can better tolerate. Or maybe just read the bill he helped write next time.