A Republican Congressman sold a Medicaid-related stock before voting for President Donald Trump 's massive tax and spending package, which affects Medicaid.

Congress has signed off on a $3.4 trillion legislative package featuring new tax breaks, spending cuts, and more funding for defense and immigration enforcement, delivering President Donald Trump his “big, beautiful bill” despite rumblings from fiscal hawks about the projected $4 trillion it could add to the national debt over the next decade.

From older adults to rural residents and immigrants, here’s who may be hit hardest if Republicans pass their sweeping health reform bill.