Under the Republicans’ tax proposal, disabled people—and other vulnerable communities—are set to shoulder a significantly greater responsibility for generating federal tax revenue, even as corporations get a substantial tax break.

The Tax Cuts and Jobs Act recommends sweeping eliminations of most itemized tax deductions and credits. Many of these deductions, taken together, serve both to ease the tax burden of people with disabilities and to improve their health and access to employment and their communities.

The provision that will have the most catastrophic effect on disabled people is the removal of the deduction for out-of-pocket medical expenses. Currently, if your out-of-pocket medical expenses exceed 10 percent of your adjusted gross income, you can deduct that from your tax bill. In the Jobs and Tax Cuts Bill, that provision is excised completely.

Depending on individual circumstances, people who pay out-of-pocket for personal care assistants and durable medical equipment would be among those experiencing the most calamitous repercussions. Someone who needs a new power wheelchair to get to work and recreational events may have to fork over tens of thousands of dollars. A caregiver who can only maintain a full-time career if she hires a personal care assistant to provide care for an aging parent may be forced to quit her job. A disabled person who can live independently in the community so long as he has a personal care assistant may have to live in a nursing home instead.

“[Disabled people are] a group at a disadvantage that’s been targeted to raise revenue,” says Thomas Cooke, a professor specializing in tax law at Georgetown University. “The broad sweep of this bill is to cut corporate taxes significantly. Somebody’s got to pay for that reduction. And I’m afraid it’s being paid on the backs of individual taxpayers, including taxpayers with disabilities and medical expenses.”

Theodore Seto, a professor specializing in tax policy at Loyola Law School, explained the philosophy underlying the medical expenses deduction. “The income tax is a tax on disposable income, and when you have a catastrophic medical expense, your disposable income really does go down. You are less able to pay than the family next door with the same income who is spending that money on hang-gliding.

“In this country we believe, and I think Republicans believe this, that someone who is out there working in the face of massive challenges…deserves credit, deserves help. And this repeal is fundamentally inconsistent with that value,” Seto continued. “This is part of a broader theme in this act. There are many parts of this act that I would characterize as kicking people when they’re down.”

The medical expense deduction is hardly a tax gimme for wealthy fat cats. As The New York Times pointed out, the medical expense deduction is the most substantial itemized tax deduction claimed by lower wage earners. Rebecca Cokley, senior fellow at the Center for American Progress who focuses on disability rights, predicted the elimination of the medical expense deduction would have “a huge detrimental impact.”

“Our general sense is that most middle income people will be slightly better off or slightly worse off on average. Where it’s really going to matter are people who are in these very specific circumstances,” said Howard Gleckman, senior fellow in the Urban-Brookings Tax Policy Center. “That’s the thing about this bill, it’s a very big deal for those who benefit from specific deductions, but less so for the average person. It’s very idiosyncratic, just depends on your individual situation.”

Gleckman observed a similar philosophy underlies the elimination of the medical expenses deduction and the casualty loss deduction, which gives a tax break to those who have experienced loss from events beyond their control, such as a hurricane. The question is whether the tax code has a responsibility to accommodate those who have financial losses that are beyond their control. The answer from the Republicans proposal is an implicit but unmistakable “no.”

Another provision that specifically affects disabled people is the elimination of a tax credit granted to businesses to comply with the Americans with Disabilities Act, or ADA. Businesses that, for example, wish to build a ramp, hire a sign language interpreter, or make their website more accessible can no longer claim this exemption. “It’s disastrous,” Cooke said.

Concurrently, there is a bill pending in the House, H.R. 620, designed to make it harder for disabled people to sue businesses that do not comply with the ADA. Suing is the primary current enforcement mechanism for failures to comply with the ADA.

If both H.R. 620 and the new plan pass, it would both be more difficult for businesses to comply with the law and they’d face fewer consequences for failing to comply. As a result, the ability of people with disabilities to enjoy their community, go out to restaurants, movies, patronize local businesses would be seriously constrained. “What few teeth there are in the ADA are gone,” commented Cokley.

Another business deduction targeted for repeal is a deduction aimed at encouraging pharmaceutical companies to develop drugs for what are known as “orphan” conditions (that is, medical conditions that are rare). It is usually not in a pharmaceutical company’s financial interest to develop drugs for such conditions, and the deduction served to incentivize the development of new drugs and treatments. If the bill passes, people with rare disorders may not get life-saving or life-improving medicines.

Unaccounted for in the tax bill’s calculations are lost revenues from disabled people and caregivers whose earning potential would be curtailed. “People with disabilities are probably the only group of Americans who want to pay taxes,” said Robyn Powell, an attorney, researcher, and writer in Boston. “We want to work and understand the importance of contributing financially so that all benefit.”

There are several proposals in the bill that are not specific to disabled people but may nonetheless increase their tax burden disproportionately. A 15 percent credit that could be claimed by seniors and those who retire on disability is now targeted for elimination.

Another credit set for repeal was designed to encourage adoptions. It will certainly affect many non-disabled people, but also targets parents who are themselves disabled. Cokley pointed out, “In my community, the dwarfism community, there’s a 25 percent miscarriage rate. Disincentives for adoption is a huge deal.”

In addition to the harms directly caused by the bill, its passage may indirectly cause even bigger hardships to disabled people.

“There are these specific deductions, but the broader problem is that this bill is part of a larger strategy of removing sources of revenue to the federal government,” said Ari Ne’eman, a disability rights activist and former Obama appointee to the National Council on Disability. He noted that less revenue in the government will result in less money for programs that affect disabled people’s lives more widely—most notably, Medicaid.

In the future, Ne’eman notes, we might say we’d really like to keep Medicaid, then bemoan that there isn’t enough money. He said, “The money isn’t there because of moments like here and now when we have a choice and we are reducing revenue.”

Cokley suggests that attempts to stop the tax bill are going to require disabled people to ally both with people who are also affected by the bill, such as cancer survivors and people with chronic illnesses, and also the broader civil rights community. “I’ve been heartened to see the civil rights community starting to speak about this. The eradication of the American dream has been happening for so many marginalized communities,” she said.

“We need all forms of activism,” she continued. “Not just people who put their lines physically, but also civil disobedience, calling members of Congress, and tweeting.” She suggested that we can’t afford to judge people on the level of activism they can provide. “It’s all hands on deck.”

Cokley posits that the deductions targeted are not arbitrarily chosen. They are specifically aimed at undermining the social safety net that has been built over a course of decades for not only disabled people, but many of our vulnerable citizens. “It clearly demonstrates a strong desire to decimate the social safety system. I don’t think anything this administration has done has been an accident,” she said. “They’re not the Bob Ross of tax policy, we’re not having happy accidents.”