Medicaid is the state's largest health insurer, covering a quarter of Michigan residents. Reform supporters say the changes will eliminate loopholes.

Florida did not expand Medicaid as most states did, so the impact may be lesser than other places, but reductions loom.

We see this budget for what it is, an extremist road map that takes away what people rely on to survive,” U.S. Rep. Maxwell Frost said at a news conference at the Pan American Behavioral Health

Democrats are already on offense.

An earlier version of the bill included exemptions for religious colleges, including Notre Dame. An Indiana senator is trying to bring it back.