The approval of the U.S. Senate’s recently unveiled health care plan would force a $2 billion reduction in Hawaii’s Medicaid program over the next ten years, according to the state’s program administrator.

A report issued by the Congressional Budget Office on Monday shows the plan, which significantly reduces the federal government’s contributions into the Medicaid program, could cause an additional 22 million Americans to become uninsured if the measure were to pass.

The impact on Hawaii would be substantial, state Medicaid officials said.

“Well, there’s about 350,000 people on Medicaid currently,” said Judy Mohr Peterson, Hawaii’s Med-QUEST Division Administrator. “That’s about one in four residents in our state, so that’s quite significant. A lot of those adults are piecing together various jobs in order to make a living, but they don’t have access to health insurance. So they rely on Medicaid.”

Faced with the prospect of losing billions of dollars, Peterson said there are only so many ways administrators will be able to make ends meet, Hawaii News Now reported.

“We only have three basic tools at our disposal in which to manage this level of a cut,” she said. “We can cut people off of services, which is something we don’t want to do. We can cut the benefits or the services. Or we could cut back on the reimbursements that we pay to providers. None of those are good options.”

The Senate health care bill, or the Better Care Reconciliation Act of 2017, is part of a broader plan that would cut the federal deficit by more than $300 billion.

GOP leaders in the Senate said they want to try and schedule a vote on the measure sometime before Friday. The measure in its current form appears to lack the necessary backing from Republicans in order to pass.