WASHINGTON ― Some of Republicans’ top ideas for reducing Medicaid spending would cut enrollment by millions, according to a new report by the Congressional Budget Office.

The analysis comes as no surprise but nevertheless could make it harder for House Speaker Mike Johnson (R-La.) to convince moderate Republicans to go along with the steep cuts sought by the more conservative faction of the House Republican conference.

Medicaid is a state-federal program that covers health care costs for more than 70 million Americans. The CBO said the various proposals to shrink the federal share of Medicaid costs would force states to pay more, shortchange health care providers, trim benefits and reduce enrollment in the program.

Republicans are looking for as much as $880 billion in savings from Medicaid to help pay for the $5 trillion in tax cuts they’re hoping to pass this year in a “big, beautiful bill” encompassing much of President Donald Trump’s domestic policy agenda.

Johnson has insisted Republicans won’t actually cut Medicaid, that they’ll simply reduce fraud, waste and abuse in the program. Democrats, who requested the CBO analysis, said it shows Johnson is wrong.

“This analysis from the non-partisan, independent CBO is straightforward: the Republican plan for health care means benefit cuts and terminated health insurance for millions of Americans who count on Medicaid,” Sen. Ron Wyden (Ore.) said in a press release. “Republicans continue to use smoke and mirrors to try to trick Americans into thinking they aren’t going to hurt anybody when they proceed with this reckless plan, but fighting reality is an uphill battle.”

One option under consideration would reduce the federal government’s match rate for Medicaid enrollees who became eligible thanks to the Affordable Care Act, the 2010 law better known as Obamacare. The CBO said this proposal would shrink Medicaid enrollment by 5.5 million and save the government $710 billion.

Another option would trim enrollment by 3.3 million through limits on Medicaid spending per enrollee who became eligible as a result of Obamacare, which expanded the program to cover able-bodied adults without children.

Moderate Republicans have already rejected the blanket reductions in federal Medicaid spending, and Speaker Johnson suggested to reporters on Tuesday evening that cuts targeting federal funding for the expansion population are off the table.

Still, moderates have said they’re on board with other ways of trimming enrollment, such as “work requirements,” or benefit limits for unemployed, able-bodied adults without dependents, and more frequent eligibility checks. The CBO has previously estimated work requirements would reduce enrollment by 1.5 million; moderates and hardliners agree that even though enrollment and spending would decline, work requirements don’t count as cuts.

But the hardliners seemed infuriated by Johnson’s remark on Tuesday. The House Freedom Caucus put out an angry statement, and Rep. Chip Roy (R-Texas) said federal match rate reductions are “necessary to stop robbing from the vulnerable to fund the able-bodied.”