WASHINGTON (AP) — House Republicans have unveiled the cost-saving centerpiece of President Donald Trump’s “big, beautiful bill,” at least $880 billion in cuts largely to Medicaid to help cover the cost of $4.5 trillion in tax breaks.

Tallying hundreds of pages, the legislation is touching off the biggest political fight over health care since Republicans tried but failed to repeal and replace the Affordable Care Act, or Obamacare, during Trump’s first term in 2017.

While Republicans insist they are simply rooting out “waste, fraud and abuse” to generate savings with new work and eligibility requirements, Democrats warn that millions of Americans will lose coverage.

A preliminary estimate from the nonpartisan Congressional Budget Office said the proposals would reduce the number of people with health care by about 860,000 a year for the next decade.

“Savings like these allow us to use this bill to renew the Trump tax cuts and keep Republicans’ promise to hardworking middle-class families,” said Rep. Brett Guthrie of Kentucky, the GOP chairman of the Energy and Commerce Committee, which handles health-care spending.

Yet Democrats said the cuts are “shameful” and essentially amount to another attempt to repeal Obamacare.

“In no uncertain terms, millions of Americans will lose their health-care coverage,” said Rep. Frank Pallone of New Jersey, the top Democrat on the panel. He said “hospitals will close, seniors will not be able to access the care they need and premiums will rise for millions of people if this bill passes.”

All told, 11 committees in the House have been compiling their sections of the package as Republicans seek at least $1.5 trillion in savings to help cover the cost of preserving the 2017 tax breaks, which were approved during Trump’s first term and are expiring at the end of the year.

The Energy and Commerce Committee has been among the most watched.

The committee was instructed to come up with $880 billion in savings and reached that goal, primarily with the health-care cuts, but also by rolling back Biden-era green energy programs.

The preliminary CBO analysis said the committee’s proposals would reduce the deficit by $912 billion during the decade, with at least $715 billion coming from the health provisions.

Central to the savings are changes to Medicaid, which provides almost free health care to more than 70 million Americans, and the Affordable Care Act, which has expanded in the 15 years since it was first approved to cover millions more.

To be eligible for Medicaid, there would be new “community engagement requirements” of at least 80 hours per month of work, education or service for able-bodied adults without dependents.

People also would have to verify their eligibility to be in the program twice a year, rather than just once.