As attention shifts to the Senate bill’s elimination of the individual mandate in the Affordable Care Act, which could increase the number of uninsured by 13 million, it is important to highlight that the House Republican tax plan also wades into health care, raising taxes on millions of Americans with high medical costs through repeal of the medical expenses deduction.

Republicans continue to press for changes to our nation’s health care system that will upend markets, breed uncertainty, and leave millions wondering whether they will have health coverage. Now, the Republican tax plan threatens significant cuts to the Medicare program. A little-known law could mean that the passage of the GOP tax reform bill will invoke massive cuts to the Medicare program, totaling around $410 billion over ten years.

Millions of working families would see tax increases under the Senate Republican tax plan. The nonpartisan Joint Committee on Taxation projects that 22 million households will see a tax increase of at least $100 in the year 2027, including 16 million who would see their taxes increase by more than $500. Most of these will be middle-class households, including 7 million households earning between $50,000 and $100,000 seeing a tax increase of at least $100.

President Trump and Senate Republicans’ tax proposal threatens to take the state and local tax deduction (SALT) away from over 40 million households. State and local deductions are not a partisan issue—both red and blue state families use them to save hard-earned money on their federal tax returns. The SALT deduction ensures Americans are not taxed twice on the same income. These deductions include write-offs for state sales, income, and property taxes. By eliminating the deduction, working Americans will face tax hikes costing hundreds or even thousands of dollars.