Changes Republicans made to their health bill to help pass it through the House would undermine insurance markets and result in millions more people without insurance, the Congressional Budget Office said, an assessment that will likely complicate the GOP’s effort to repeal Obamacare.

The CBO, which acts as Congress’s actuarial arm, said Wednesday that the legislation would increase the number of uninsured by 23 million. The changes also mean that in some states, older or sicker people might not be able to afford health insurance plans. And women might be forced to pay $1,000 a month to buy coverage for maternity care.

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