A new hurdle for poor Americans, approved by the House, would cause millions to lose coverage, including many who are working but can’t meet reporting rules.

Last-minute changes to the GOP budget plan that House Republicans voted through early Thursday morning may have a wider impact on Medicaid coverage for mental health services. More than 70 million Americans rely on government programs like Medicaid for healthcare.

The U.S. House early Thursday approved the “big, beautiful bill” that Republican leaders spent months negotiating with centrists and far-right members of the party — two distinct factions that hold vastly different policy goals — over intense opposition from Democrats.