Veronica Montoya relies on Medicaid for the $15,000 infusions that restrain her immune system from attacking her body, and worries she may lose that access if Congress adopts drastic changes to the health care program.

Provisions of congressional Republicans’ “One Big Beautiful Bill Act” would add work requirements for some people covered by Medicaid and require them to go through the full process of proving eligibility twice a year instead of once.

The bill, backed by President Donald Trump, also would restrict immigrants’ access to health insurance and raise costs for people who buy their health coverage on the exchange, while extending tax cuts for higher earners and spending more on national defense.

Taken together, the provisions would create hurdles for people who don’t have job-based coverage to find and keep health insurance through Medicaid or the marketplace, even if they are employed or have a disability. While the bill wouldn’t entirely return the U.S. health insurance market to its pre-Affordable Care Act state, it would take away options that helped bring down the uninsured rate, experts said.

The House passed the legislation in late May by a single vote. The bill’s chances in the Senate aren’t clear; both fiscal hawks and centrist Republicans have expressed concerns.

At face value, the work requirements shouldn’t affect Montoya, because she has a disability and has caregiving responsibilities for her mother. But she also knows proving that could be a problem. Even without changes, Montoya said she sometimes struggles to prove her continuing eligibility because her condition causes “brain fog.”