Republicans had one top priority for their health care bill: it had to lower insurance premiums. “The price has to come down, period,” Rep. David Brat of Virginia told TIME in March. Lowering premiums was the biggest sticking point for getting the bill out of the House. So when the Congressional Budget Office released a dismal forecast for the American Health Care Act, projecting 23 million fewer people would have insurance under the Republican law in 10 years, House Speaker Paul Ryan tried to focus on the bright side. “What CBO just told us is the reforms we put in this bill will help lower premiums, and so I’m very encouraged by that,” Ryan told reporters Thursday. But such predictions are difficult, particularly in health care.