In a speech from the White House balcony facing the South Lawn, Trump thanked Republican lawmakers who helped usher the bill to his desk. He touted the tax cuts in the bill, brushing aside criticism of the impact to social programmes such as food assistance and Medicaid.

President Trump and Republicans’ tax law is one of the most significant pieces of health care legislation since the ACA. It centers on this very regressive tradeoff: Poor and middle-class workers will lose their health coverage, while affluent households will reap the largest benefits of tax cuts.