The Congressional Budget Office (CBO) predicts that the Senate health care bill will cause 22 million people to lose their health insurance over the next decade.

The CBO’s estimate carries real power. In March, the House scrapped its first attempt at a health care vote due in part to the office’s estimate, which was released 10 days before the scheduled vote. That estimate said the bill would rob 24 million people of coverage. Ultimately, House Republicans didn’t wait for an updated CBO estimate on the final version of the bill, and voted to pass it anyway on May 4, sending it to the Senate. Weeks later, the CBO determined that the House bill would cost 23 million people their coverage.

The current Senate bill, which would go to the White House if passed and presumably be signed into law, is already threatened by several Republicans who have either opposed the legislation, or refused to commit to voting for it. Republican Senators Rand Paul (Kentucky), Ted Cruz (Texas), Ron Johnson (Wyoming), Dean Heller (Nevada), and Mike Lee (Utah) have announced their opposition to the bill in its current form, and Susan Collins (Maine) has expressed concerns. The CBO score could push moderates to oppose the bill.