Congress’ official scorekeeper says repealing Obamacare would increase the federal budget deficit and the number of uninsured Americans by 24 million.

The report from the Congressional Budget Office comes as Washington awaits a ruling by the Supreme Court that could end insurance subsidies for some six million people in 30 states.

The report says repealing the Affordable Care Act’s spending cuts and tax increases would add $137 billion to the deficit over the next ten years, and the number of people with health insurance would drop from 90 percent of the population to 82 percent.

The CBO says economic growth would be boosted a bit because more people would join the labor force, as the Affordable Care Act’s subsidies make it easier for people to work less or stop working and not lose health coverage.

Reaction to the report, as with most things about the health care law, fell along party lines. The chairman of the Senate Budget Committee, Republican Mike Enzi of Wyoming, chose to focus on how repeal would effect economic growth:

“‘CBO has determined what many in Congress have known all along,’ said Chairman Enzi. ‘This law acts as an anchor on our economy by dragging down employment and reducing labor force participation. As a result, the deficit reduction that the Democrats promised when it was enacted is substantially unclear.'”

Democrats put their focus on the negative impacts of repeal. House Minority leader Nancy Pelosi said:

“The cost to the deficit would be surpassed only by the human toll of repeal. Republicans would add over 20 million Americans to the ranks of the uninsured, and strip vital health protections from hundreds of millions of American families – shattering the newfound health security that has made a difference in the lives of so many families. Republicans should look at the numbers and finally end their fixation with repealing this historic law.”

The new CBO report incorporates the principles of dynamic scoring, which takes into account a wider array of economic factors, and which Republicans say provides a more realistic picture of the economic impact of repeal. The CBO says under the old rules, the deficit would increase even more, by $353 billion over ten years.

Politico says the CBO report could have political implications:

“The estimate will make it harder for Republicans to use so-called reconciliation to repeal the law because congressional budgeting rules bar lawmakers from using the parliamentary maneuver to move legislation that adds to government red ink.

The CBO report said over the long term, repeal would add even more to the deficit:

“Repealing the ACA would cause federal budget deficits to increase by growing amounts after 2025, whether or not the budgetary effects of macroeconomic feedback are included. That would occur because the net savings attributable to a repeal of the law’s insurance coverage provisions would grow more slowly than would the estimated costs of repealing the ACA’s other provisions—in particular, those provisions that reduce updates to Medicare’s payments. The estimated effects on deficits of repealing the ACA are so large in the decade after 2025 as to make it unlikely that a repeal would reduce deficits during that period, even after considering the great uncertainties involved.”

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Federal agents have arrested 243 people — including 46 doctors, nurses and other medical professionals — who are accused of running up more than $700 million in false Medicare billings. Charges range from fraud and money laundering to aggravated identity theft and kickbacks.

Attorney General Loretta Lynch calls it “the largest criminal health care fraud takedown in the history of the Department of Justice.”

One California doctor is accused of causing nearly $23 million in fraud losses, due to illegal practices that involved “over 1,000 expensive power wheelchairs and home health services that were not medically necessary and often not provided.”

The arrests took place over three days in 17 cities. The FBI says more than 44 of the defendants defrauded Medicare’s Part D prescription drug program.

Others are charged with running schemes based on overstating treatment times — and in one case, the defendants are accused of billing Medicare millions of dollars for equipment that were either not needed or requested.

More than 900 law enforcement officials were involved in the arrests, which the Justice Department says are the latest in a crackdown on Medicare fraud.

Since it was formed in 2007, the Medicare Fraud Strike has “charged over 2,300 defendants who collectively have falsely billed the Medicare program for over $7 billion,” the government says. It adds that in that same span, the strike force has prosecuted more than 200 doctors and more than 400 medical professionals.

Last summer, our colleagues at the Shots blog reported on a separate prescription drug scheme that unraveled after a doctor’s Part D billing soared to nearly $5 million. In that case, two secretaries at the doctor’s clinic were found to have faked prescriptions.

Announcing this week’s arrests, officials said, “the Centers for Medicare & Medicaid Services also suspended a number of providers.”

From the FBI’s news release, here are more of the charges:

Miami: 73 defendants were charged with offenses relating to their participation in various fraud schemes involving approximately $263 million in false billings for home health care, mental health services and pharmacy fraud. In one case, administrators in a mental health center billed close to $64 million between 2006 and 2012 for purported intensive mental health treatment to beneficiaries and allegedly paid kickbacks to patient recruiters and assisted living facility owners throughout the Southern District of Florida. Medicare paid approximately half of the claimed amount.

Houston and McAllen, Texas: 22 individuals were charged in cases involving over $38 million in alleged fraud. One of these defendants allegedly coached beneficiaries on what to tell doctors to make them appear eligible for Medicare services and treatments and then received payment for those who qualified. The company that paid the defendant for patients submitted close to $16 million in claims to Medicare, over $4 million of which was paid.

Dallas: Seven people were charged in connection with home health care schemes. In one scheme, six owners and operators of a physician house call company submitted nearly $43 million in billings under the name of a single doctor, regardless of who actually provided the service. The company also significantly exaggerated the length of physician visits, often times billing for 90 minutes or more for an appointment that lasted only 15 or 20 minutes.

Los Angeles: Eight defendants were charged for their roles in schemes to defraud Medicare of approximately $66 million. In one case, a doctor is charged with causing almost $23 million in losses to Medicare through his own fraudulent billing and referrals for DME, including over 1000 expensive power wheelchairs and home health services that were not medically necessary and often not provided.

Detroit: 16 defendants face charges for their alleged roles in fraud, kickback and money laundering schemes involving approximately $122 million in false claims for services that were medically unnecessary or never rendered, including home health care, physician visits, and psychotherapy, as well as pharmaceuticals that were billed but not dispensed. Among these are three owners of a hospice service who allegedly paid kickbacks for referrals made by two doctors who defrauded Medicare Part D by issuing medically unnecessary prescriptions.

Tampa: Five individuals were charged with participating in a variety of schemes, ranging from fraudulent physical therapy billings to a scheme involving millions in physician services and tests that never occurred. In one case, a licensed pain management physician sought reimbursement for nerve conduction studies and other services that he allegedly never performed. Medicare paid the defendant over $1 million for these purported services.

Brooklyn, N.Y.: Nine individuals were charged in two separate criminal schemes involving physical and occupational therapy. In one case, three individuals face charges for their roles in a previously charged $50 million physical therapy scheme. In the second case, six defendants were charged for their roles in a $8 million physical and occupational therapy scheme.

New Orleans: 11 people were charged in connection with $110 million in home health care and psychotherapy schemes. In one case, four individuals who operated two companies—one in Louisiana and one in California—that mass-marketed talking glucose monitors (TGMs) across the country allegedly sent TGMs to Medicare beneficiaries regardless of whether they were needed or requested. The companies billed Medicare approximately $38 million for the devices and Medicare paid the companies over $22 million.

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