Trump signed the multitrillion-dollar legislation outside the White House, and then banged down the gavel that House Speaker Mike Johnson gifted him that was used during the bill’s final passage Thursday.

The president’s sweeping domestic policy achievement extends his expiring 2017 tax cuts, but could cause millions in the U.S. to lose their health coverage and food aid over the next decade.

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.