The Congressional Budget Office today released two new estimates about the Affordable Care Act. One is the latest update on what will happen when the Affordable Care Act is implemented — and in particular, how things change thanks to the Supreme Court’s ruling that in effect makes Medicaid expansion optional for the states. The second is the effect of the latest repeal bill that the House recently passed.

The bottom line? CBO says that the House repeal bill would increase the deficit by $109 billion over 2013 through 2012. They also say that thanks to the Supreme Court decision allowing states to opt out of the Medicaid expansion, CBO now expects overall spending by the federal government to be a little less. CBO estimates $84 billion over 2012 through 2022 — while about 3 million more American will remain without health insurance than if health care reform were implemented as originally passed.

On repeal: this is yet another reminder that the supposedly deficit-concerned Republican Party still hasn’t come to grips with what the Affordable Care Act actually does, either in health care policy or in terms of the federal budget. They just don’t want to accept that the Democratic health care reform bill was designed to lower the deficit — in part through extra taxes and fees, to be sure, but also to some extent through real cost savings. Either way, just flat-out repeal it and the deficit goes up.

Two points. First, anyone who actually cares about deficits should be very clear about the difference between the fully-funded Affordable Care Act and budget-busters passed by Republicans while George W. Bush was president, including Medicare Part D and, of course, massive tax cuts. Whatever one feels about the merits of these programs, it’s absolutely clear that there’s a big difference between the parties when it comes to deficits. And the fact that Republicans still want to repeal health care reform without doing anything at all about the effect on the deficit shows that those differences are no Bush-era aberration.

Second, for those of us who are not particularly concerned about deficits, what’s really important, on the economic side, is finding a way to control long-term health care costs. We don’t yet know how well the Affordable Care Act will achieve that. We do know it’s a serious attempt. We also know that if they were to repeal the law, Republicans would replace it with: nothing. And without some sort of action, health care costs threated to either ruin the federal government’s ability to stay solvent, or the private sector’s health, or (most likely) both.

All of which is why it really does matter a lot that the “replace” in the Republican-claimed “repeal and replace” plan is a pure, total, myth. And today’s CBO report simply pounds that home one more time.