The implementation of a work requirement for many able-bodied people to get health insurance coverage under Medicaid is part of President Donald Trump’s “Big Beautiful” bill that cleared the House last month and is now up for consideration in the Senate. Trump is seeking to have it passed by July 4.

The bill as it stands would cut taxes and government spending, and also change portions of the nation’s social safety net.

For proponents, the ideas behind the work requirement are simple: Crack down on fraud and stand on the principle that taxpayer-provided health coverage isn’t for those who can work but don’t. The measure includes exceptions for those who are under 19 or over 64, those with disabilities, pregnant women, main caregivers for young children, people recently released from prisons or jails, or during certain emergencies. It only would apply to adults who receive Medicaid through expansions that 40 states chose to undertake as part of the 2010 health insurance overhaul.

Many details of how the changes would work would be developed later, leaving several unknowns.

Advocates and sick and disabled enrollees say they are concerned — based largely on their past experience — that even those who might be exempted from work requirements under the law still could lose benefits because of increased or hard-to-meet paperwork mandates.

The bill the House adopted would require Medicaid enrollees to show that they work, volunteer or go to school at least 80 hours a month to continue to qualify.

About 71 million adults are enrolled in Medicaid now. Most of them — around 92 percent — are working, caregiving, attending school or disabled.

Earlier estimates of the budget bill from the Congressional Budget Office found that about 5 million people stand to lose coverage.

A KFF tracking poll conducted in May found that the enrollees come from across the political spectrum. About one-fourth are Republicans; roughly one-third are Democrats.

The poll found that about 7 in 10 adults are worried that federal spending reductions on Medicaid will lead to more uninsured people and would strain health-care providers in their area.

About half said they were worried reductions would hurt the ability of them or their family to get and pay for health care.

Amaya Diana, an analyst at KFF, points to work requirements launched in Arkansas and Georgia as keeping people off Medicaid.

Amber Bellazaire, a policy analyst at the Michigan League for Public Policy, said the process to verify that Medicaid enrollees meet the work requirements could be a key reason people would be denied or lose eligibility.

“Massive coverage losses just due to an administrative burden rather than ineligibility is a significant concern,” she said.