WASHINGTON (AP) — Approximately 11.8 million adults and children could lose their health insurance if a proposed Republican policy package becomes law.

The impact won’t be immediate. The Republicans’ “One Big, Beautiful Bill Act” proposes adjustments that will gradually reduce enrollment in federal health programs, such as Medicaid and Obamacare, over ten years, aiming to cut nearly $1 trillion from Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program.

This legislation is expected to reverse the upward trend in health insurance rates in the U.S., which has been characterized by record levels of spending on federally-backed health care coverage. Currently, around 78 million adults and children participate in Medicaid programs, and 24 million people are part of the ACA’s marketplaces.

Medicaid is a joint federal-state venture that is administered by the states. The program goes by different names in some states, like Medi-Cal in California, BadgerCare in Wisconsin, or MassHealth in Massachusetts.

A look at some of the ways in which people may lose health care coverage under the GOP’s plan:

Medicaid or Obamacare enrollee? Your income and eligibility will be checked closely and more often.

Under the GOP’s plan, states will need to verify a person’s income to check Medicaid eligibility every six months.

People who are homeless or transient may miss notices from the government to fill out paperwork more frequently, said Martha Santana-Chin, the CEO of L.A. Care Health Plan, which provides Medicaid for millions of Los Angelenos. They’ll lose their coverage if they don’t respond.

“The life experience of these individuals is not necessarily one that allows them the luxury of having to work through onerous paperwork,” Santana-Chin said.

When Texas increased income eligibility checks between 2014 and 2019, for example, thousands of kids lost coverage in the state. Critics faulted the frequent checks, too, for the state having the highest rate of uninsured children in the nation at the time.

States will also be required to check enrollees’ addresses and death records more frequently.

People enrolled in the ACA’s marketplace coverage will also be subject to more scrutiny over their reported income and face penalties if they end up earning more than they expected when signing up for the coverage. They’ll have to wait for the government to verify their information, too, before getting coverage.

It will be a sharp contrast from employer-based coverage, where people are re-enrolled every year unless they opt out.

Is your child enrolled in coverage?

States will be allowed to delay kids from enrolling in the Children’s Health Insurance Program in some cases.

They will be allowed to temporarily block parents from enrolling their children if they are behind on paying the premiums for the coverage. Those premiums for kids’ coverage can run as much as $100 a month in some states, according to health policy research firm KFF. States will also be able to introduce a waiting period for kids who are being transitioned from private health insurance plans to Medicaid.

The Biden administration prohibited states from locking out parents from enrolling their kids in coverage over missed payments or a waiting period when transitioning from private health insurance.

Are you an immigrant? Getting coverage may get harder.

The bill narrows the definition of who qualifies for lower Obamacare, restricting access for thousands of refugees and asylum seekers who come to the U.S. every year.

States that offer Medicaid coverage to cover immigrants who may not be here legally will also receive less money from the federal government. Several states allow immigrants to enroll in Medicaid, paid for only using state tax dollars. But the bill threatens that coverage by lowering the rate the federal government pays for all legal residents from 90% to 80%.

That will lead some states to drop their program for immigrants entirely rather than lose federal funding. Already, California has announced a freeze on any new enrollment for the state funded Medi-Cal for all immigrants. Illinois, meanwhile, halted its program this month.

Able-bodied? You’ll have to work, volunteer or go to school.

Most coverage losses are expected to come from the GOP’s proposed work requirement. People aged 19 through 64 will be required to work, volunteer or go to school for 80 hours per month in order to qualify for Medicaid under the new law. They’ll be exempt if they’re disabled, pregnant or parent a child who is 14 or younger.

Ultimately, some people will decide they don’t want to work and don’t need the coverage, said Michael F. Cannon, director of health policy studies at the libertarian think tank Cato Institute.

“It can encourage people who don’t value Medicaid coverage not to sign up for it,” Cannon said. “And that saves the government money.”

Most Medicaid enrollees already work, attend school, have a disability or are caregivers, which should exempt them from the requirement. Only about 8% of enrollees report not working or being unable to find work.

In some cases, people will lose coverage even if they’re working. They will fall victim to bureaucratic errors, overlooked forms, or trouble getting all of the documents — like proof of employment and tax forms — together to prove to the government that they’re working. Verifying work will be especially difficult for people who don’t have access to the internet, a computer or phones.

That’s how some people lost coverage in Arkansas, which tried to enact work requirements in 2018. Roughly 18,000 people were pushed off Medicaid within seven months. A federal judge later blocked the requirement.

Enrolled in both Medicare and Medicaid? It will be harder to apply

Millions of people qualify for both Medicare and Medicaid, often because of a disability.

The GOP bill will roll back requirements of the ways the Biden administration streamlined enrollment for those people, including a rule that required states to automatically enroll people into coverage if they qualify for supplemental income because of a disability.

“By rescinding these rules and no longer requiring states to make some of these simplifications, it’s likely that some people will lose coverage because they get caught up in these paperwork burdens,” said Jennifer Tolbert, director of state health policy at KFF.