In a marathon session marked by the arrest of dozens of disability rights activists, Republicans in the U.S. House of Representatives pushed ahead with plans to drastically reduce Medicaid spending.

The House Energy and Commerce Committee voted 30 to 24 on Wednesday to send the measure to the full House.

The plan, which is part of a broad reconciliation bill designed to make good on President Donald Trump’s domestic agenda, calls for imposing work requirements on many Medicaid beneficiaries, mandating that states check individuals’ eligibility for the program more frequently and other changes.

The Congressional Budget Office estimates that the measure would reduce health spending — much of which comes from Medicaid — by at least $715 billion and leave 8.6 million people without health insurance. Savings from Medicaid and elsewhere would help offset an extension of tax cuts from Trump’s first term and support other administration priorities.

The oftentimes testy hearing, which spanned more than 26 hours, started off with protesters chanting “no cuts to Medicaid.” U.S. Capitol Police arrested 26 demonstrators, including 25 members of the disability rights group ADAPT, pushing many out of the hearing room in their wheelchairs.

“Cuts to Medicaid will mean I lose services, or have them cut,” said Latoya Maddox of Philadelphia ADAPT, one of 150 activists with disabilities from more than 20 states who came to Capitol Hill to speak out. “If I lose my services, my attendants who have families to support, don’t get paid. If my services get cut, it will mean I can’t work because there is no one to help me bathe and dress for work. If I can’t work, I won’t be able to support my son or pay my rent, and I will be evicted and forced into a nursing home where I will lose my freedom and control over my life. I am here fighting for my life!”

Republicans said that their bill will end “waste, fraud and abuse” in Medicaid and maintain coverage for those who need it.

“Our priority remains the same: strengthen and sustain Medicaid for those whom the program was intended to serve: expectant mothers, children, people with disabilities and the elderly,” said Rep. Brett Guthrie, a Kentucky Republican who chairs the committee.

The bill does not overtly detail cuts to services for people with disabilities, but Democrats said there is no doubt the plan would do just that.

“To all my colleagues who say you’re cutting waste and fraud, Medicaid is 22% more cost-effective than any private insurance plan,” said Rep. Debbie Dingell, D-Mich., who highlighted the family of a 6-year-old with Down syndrome named George who came to the hearing. “We have to protect George, other children, seniors in nursing homes and people with disabilities. Please don’t say you’re not going to hurt them, because many things in this bill are a back-door way of doing so.”

Advocates who have been warning for months about the threat of Medicaid cuts to people with disabilities said the stakes could not be higher.

“This is the largest Medicaid cut in history, and it would be disastrous for disabled people who depend on Medicaid,” said Zoe Gross, director of advocacy at the Autistic Self Advocacy Network.

Increasing the frequency of eligibility checks will mean that people who qualify for Medicaid are cut off due to paperwork issues or bureaucratic errors, Gross said. Moreover, new requirements in the bill that could limit federal Medicaid matching funds to states will force difficult choices.

“When states receive less money from the federal government to fund Medicaid, they don’t make up the difference out of their state budgets. Instead, they implement cuts where they can — meaning, cuts to provider payments and to optional benefits like (home and community-based services),” Gross said.

The Medicaid home and community-based services system is the backbone of the nation’s supports for individuals with developmental disabilities and it’s already under pressure.

More than 700,000 people are on waiting lists for Medicaid waivers, which provide home and community-based services, according to KFF, a nonprofit that conducts health policy research. And even those with waivers have had difficulty accessing supports in recent years.

A national survey of almost 500 community-based services providers late last year found that nearly all had experienced moderate or severe staffing shortages in the previous year. As a result, 69% had declined new clients and 39% closed programs or services, with over a third saying they were considering further cuts.

“These cuts, even if not specifically directed at community-based disability services, will squeeze a system already in crisis, harming people with disabilities and the workers supporting them,” said Barbara Merrill, chief executive officer at the American Network of Community Options and Resources, or ANCOR, which represents disability service providers nationally. “Despite the insistence by many members of Congress that they don’t want to cut benefits for people with disabilities, drastic funding cuts of any kind will reverberate across states, thereby endangering community-based disability services — the kinds of services that are often first to go when states experience funding shortfalls.”

“We urge members of Congress to reject this legislation when it is up for a vote on the House floor,” Merrill added.