Conservative Senate Republicans are weighing faster and steeper cuts to Medicaid that could drop millions of people from coverage and mark the biggest changes to the program in its 52-year history.

The plan being pushed by lawmakers such as Mike Lee (R., Utah) is likely to face resistance from centrist GOP senators who are already concerned a health-overhaul bill passed by House Republicans would leave too many people uninsured. But the push for more aggressive Medicaid cutbacks indicates that if a bill ultimately passes both chambers, it could significantly scale back the federal-state insurance program that covers 73 million low-income or disabled Americans.

Other measures in the Republican health initiative have drawn big headlines, but the Medicaid plan could affect many more people and shift significant costs onto hospitals and states.

“Much of the focus so far has been on pre-existing conditions, because it’s easier to understand than a program for the low income,” said Diane Rowland, executive vice president at the Kaiser Family Foundation. “But if you phase back expansion, you’ll see a large number of low-income adults without access to care.”

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Senate Republicans’ plan could drop millions from Medicaid