The U.S. social safety net would be jolted if the budget bill backed by President Donald Trump and passed Thursday by the House of Representatives becomes law.

It would require many low-income adults to work to receive Medicaid health insurance coverage and more to work to get food assistance, require hospitals to verify the citizenship status of patients, and cut funding for services like birth control to the nation’s biggest abortion provider.

Supporters of the bill say the moves will save money, root out waste and encourage personal responsibility.

A preliminary estimate from the nonpartisan Congressional Budget Office said the proposals would reduce the number of people with health care by 8.6 million over the decade.