DES MOINES, Iowa (AP) — An Iowa Senate subcommittee has advanced a bill that would require tens of thousands of Medicaid recipients to work to keep their benefits. Medicaid is a health insurance program for poor or disabled people paid for with federal and state money. Among those covered in Iowa are 172,000 adults living in poverty who were added to the program as part of a health care insurance expansion enabled by the Affordable Care Act.

Republican Sen. Jason Schultz says there’s a “groundswell of support” for a work requirement in his northwest Iowa district. State officials say about 60,000 people could be affected by the bill, which requires recipients to work or volunteer at least 20 hours per week. Opponents say it could kick people off Medicaid who must stay home, such as to care for a parent with Alzheimer’s.

The nonpartisan Kaiser Family Foundation says seven other states have similar laws, including Arkansas where 18,000 Medicaid recipients were kicked off their health insurance after last year’s enactment of the law.