For the years since the debate over the Affordable Care Act began, anti-government Republicans (is there another kind?) have been bitching about the individual mandate that required people to buy insurance.Now it s their turn to come up with an alternative, and while theirs will cover fewer people, their solution is to force everyone to buy it, regardless of whether they can afford the barely subsidized coverage.The addition, which was tacked onto the Republican healthcare bill on Monday, is somewhat different from the individual mandate in the Affordable Care Act, which says that there would be a penalty for people who lack coverage for more than 63 days. In the GOP bill, it s even worse. People would be barred from coverage at all for six months if they have a 63 day gap.Republicans added this provision after economists and health policy experts convinced them that it would be unsustainable to not force people to purchase insurance.Health policy experts across the political spectrum had warned that the initial Senate bill s failure to include some penalty for going uninsured could cause a  death spiral  in which people go without health insurance while healthy and only buy it when they become sick. In that scenario, insurance premiums shoot up for everyone as insurance markets become flooded with customers who disproportionately require expensive treatments.Source: NBC NewsThe main difference between this and the Affordable Care Act, though, is that the cost of premiums are going to be much higher. According to the Congressional Budget Office, 22 million Americans stand to lose their healthcare coverage if the GOP bill becomes law.By and large, Republicans want to do away with the Medicaid expansion, which allowed poorer people access to insurance, often without paying anything. Everyone who makes under $48,000 a year receives subsidies to help pay for insurance under the Affordable Care Act. Instead with Trumpcare, they want to offer those people a block grant, which would severely restrict medical spending. Instead of subsidies, there will be tax credits.Some who aren t receiving Medicaid or Medicare might see more affordable premiums, but that s only because the coverage will be so much less.Republicans have now chosen to take the most controversial portion of the Affordable Care Act and make it absolutely draconian. If you happen to be one of the 22 million who loses insurance, good luck getting it back.Featured image via Chip Somodevilla/Getty Images