Approximately 100,000 Coloradans would lose their health care under a bill that cleared its first hurdle in Congress.

That's according to the non-partisan Congressional Budget Office, which says Medicaid spending would continue to grow under the bill, but it would grow by about $700 billion less over the next decade than it is projected to grow now.

The House Committee on Energy and Commerce passed the bill, that's a key part of the Republican budget, after a tense 26 1/2 hour hearing.

Protestors in wheelchairs gathered outside the committee room and begged lawmakers to spare Medicaid.

"It honestly breaks my heart the fear mongering that's occurring in this place," said Colorado Congressman Gabe Evans, who sits on the committee and voted for the bill.

He says studies show Medicaid spending is unsustainable, and the bill will protect the safety-net program for those who need it most by purging the rolls of those who aren't eligible.

"I voted to keep 1.4 million illegal immigrants from cutting in line and taking taxpayer money away from disabled peoples and from pregnant women and from kids. I voted to clean up our Medicaid rolls and keep 1.2 million people who aren't eligible for the program from cutting in line and taking money away from those who need it most," Evans said.

The most controversial provision in the bill involves so-called community engagement requirements. Able-bodied recipients without dependents would have to prove they are working, volunteering, or going to school 80 hours a month.

"Asking people to receive taxpayer-funded health care by being engaged with their community for 20 hours a week. I think that's a very reasonable request," said Evans.

Kim Bimestefer -- Executive Director the Colorado Department of Health Care Policy and Financing (HCPF), which administers Medicaid -- says the work requirements will cost more than they will save.

"We need to realize that individuals are may not be working because they just lost their jobs and they're in transition, and that period of transition can vary depending on where we are in the economy," she said.

One in four Coloradans get their health coverage through Medicaid. HCPF estimates half of them are already working.
If they must verify their work status every month, Bimestefer says, it will mean a new $57 million administrative burden based on other state's experience.

Evans says the money they would save from removing ineligible participants would help cover that cost. He says those who already meet work requirements for Temporary Assistance for Needy Families (TANF) or food stamps (SNAP) would receive a verification waiver under Medicaid.

Bimestefer says she supports more efficiency in the system, but not putting up barriers to care for those who qualify.

"If they cut monies we cannot backfill. We have to begin to cut some way shape or form across Medicaid, and that will have an impact to families, to providers, to our economy and all Coloradans as those costs need to shift that aren't covered," she said.

The bill also includes new cost-sharing requirements for people at or near the poverty line and requires states to verify a person's eligibly twice a year instead of once a year. Bimestefer says HCPF already runs quarterly income checks through the Department of Labor and Employment but, a full eligibility review semi-annually would be another expensive -- and she says unnecessary -- administrative burden.

The bill could also cost Colorado millions of dollars due to a provision that cuts federal funding by 10% to states that provide Medicaid for non-citizens. HCPF estimates it will spend $51 million on health care for non-citizens this year.

The measure still needs to pass two more committees before it's debated on the House floor and then the Senate repeats the process. Many of the bill's provisions don't take effect until 2029.