Republicans in Congress are continuing to refine their proposal for significantly cutting the country’s Medicaid program — this is a key part of the GOP’s big tax bill. Not even all Republicans agree on major cuts to this program, which is funded jointly by states and the federal government. It provides health insurance to 80 million low-income Americans.

But one policy proposal has support from nearly all GOP officials: Start forcing most adults enrolled in Medicaid to work.

Ryan Levi is a producer with the nonprofit health policy news organization Tradeoffs. He’s been reporting on this and spoke about it with “Marketplace Morning Report” host David Brancaccio. The following is an edited transcript of their conversation.

David Brancaccio: So you have to work in exchange for the health care plan. What would be some of the rules?

Ryan Levi: So the GOP plan says that in order to qualify for Medicaid, adults under 65 must either work, volunteer, go to school or be in a work training program for at least 80 hours every month. Now, there are exceptions — if you're pregnant, for folks who are disabled or caregivers. An early analysis from the nonpartisan Congressional Budget Office says that this policy would save the federal government $280 billion over the next decade, and nearly 5 million people would lose their health insurance as a result.

Brancaccio: Big cost savings in vision, but also 5 million low-income people losing health coverage. But I don't get it. I've seen research showing 90% of people on Medicaid now are either working already or would qualify for one of those exemptions you listed. Given that, why would this policy kick so many people off of Medicaid?

Levi: Two words: red tape. Back in 2018, Arkansas became the first state to impose work requirements in Medicaid. And Ben Sommers, who's a Medicaid researcher at Harvard, he told me that studies suggest most of the 18,000 people who lost coverage under that policy were still eligible. People just didn't know about the work requirements or they struggled to figure out how to report their hours.

Ben Sommers: It’s really hard to craft a work requirements policy in Medicaid that's going to move the needle substantially on employment without catching a lot of people up in red tape, because so many folks are already doing what you want them to do.

Brancaccio: So, Ryan, would Republicans in Congress take a more streamlined approach — less hoops than the Arkansas model studied there?

Levi: It depends who you ask. This proposal would only make people report their work hours twice a year instead of every month, like Arkansas did. It also directs states to use data they already have, like payroll taxes, to limit the paperwork that people have to send in. That's going to be an easier lift for some states than others. One thing that's not in this proposal are any provisions about actually helping people find jobs before kicking them off Medicaid. That's something that several former Medicaid directors from red states told me is really important, if the goal of this is to actually help people break the cycle of poverty, get a leg up in life, as opposed to just reducing costs by shrinking Medicaid.