The GOP faces another judgment day on healthcare

The Congressional Budget Office on Wednesday is set to release its latest score for the American Health Care Act, the GOP bill to repeal and replace Obamacare, in a move that has been highly anticipated for weeks.

The score will measure the AHCA's potential effects total number of people with insurance coverage, the increase or decreases in the federal deficit due to the bill, and other measures over the next decade.

The bill has been scored twice before. But two amendments that were added to the bill just before it passed through the House of Representatives have changed the game significantly for the CBO score.

While Republicans have sought to downplay the score ahead of its release, it could have serious implications for the future of the AHCA.

The technical test

The most important aspect of the bill for Republicans will come in how the CBO scores the AHCA's potential effect on the federal deficit.

The GOP is using the budget reconciliation process for the AHCA. The procedure allows them to need only a simple majority in the Senate to pass the bill and avoid a Democratic filibuster.

In order to use this procedure, however, Senate rules mandate the bill must save at least $2 billion.

Just before the AHCA passed through the House, Republicans added two amendments to the bill. One of those would allow states to opt out of two Obamacare regulations with a waiver from the federal government, and another calls for an additional $8 billion in funding to protect people with preexisting conditions.

Those two factors could shave off some of the $151 billion in deficit savings from the previous scoring of the bill, and it could affect the bill's future.

Given the uncertainty, House Republicans have not yet sent the bill along to the Senate in case another amendment is needed to add savings to the bill. A GOP aide told Business Insider that the delay, however, is simply "an abundance of caution" on the part of leadership.

The public-relations test

All versions of the American Health Care Act have been unpopular with the American public. The new CBO score could make it even worse.

The previous score estimated that 24 million fewer Americans would have health coverage by 2026 than under the current baseline. Democrats have seized on that number to attack the bill.

Any change to that statistic could be the headline-grabbing feature of the new score.

Margot Sanger-Katz at the New York Times polled six healthcare experts ahead of the new CBO score, and their estimates ranged from 20 million more uninsured to 25 million.

Cynthia Cox, associate director at the nonpartisan Kaiser Family Foundation, said there is a chance the new amendments added to the AHCA could bring down the number of people without coverage.

"I think we could still see substantial coverage losses but maybe not to the same degree as the previous CBO score," Cox told Business Insider. "The reason for that would be that the waivers that states would take up could mean more healthy people are able to purchase insurance. Sick people would be more likely to be priced out of the market in states that take up the waiver, meaning those exchanges would be more affordable for healthy people to get in."

Put another way, if states take up waivers and insurers are able to price some sicker people out of the market, premiums could drive down, incentivizing more healthy people to enter the exchanges. However, this would assume that a good number of people with preexisting conditions would go uncovered.

This also plays into the budget dynamic, according to Cox, because the more people that are covered the more people will use the tax credit which will cost the federal government more.

Matthew Fiedler, a fellow at the Brookings Institution's Center for Health Policy, said that while there may be a decrease in the number without coverage, the changes would likely be at the margins and still leave millions without coverage.

"It's important not to get too focused on the change between the last score and this score because what we know for sure is the CBO is going to show a very large coverage loss under this bill, and all we'll learn from the score is just how large," Fiedler told Business Insider.