President Donald Trump on Friday signed into law his sweeping tax cut and spending package, what he’s called the “big, beautiful bill,” in a Fourth of July ceremony packaged with patriotic pomp and symbolism.

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.