Imagine two couples, both alike in incomes, in a state without income tax where we lay our scenario. They have $150,000 in income and $100,000 in medical expenses and take no other itemized deductions.

Now imagine that one gets a deduction for medical expenses and one does not. Using the 2017 tax brackets and a rule that would not allow medical deductions unless they exceed 10 percent of adjusted gross income, a couple that could access the deduction would end up with $15,547 more at the end of tax season than one that could not deduct and thus paid more in taxes, according to calculations that Ruth A. Sattig Betz, an accountant in Farmingdale, N.Y., ran for me.

Take the income down to $75,000 (where the extra $25,000 for the medical costs to pay the $100,000 in bills would come from sources or savings that are not subject to income tax) and the household with the ability to take the deduction would end the year with $6,826 more.

So the medical expenses clearly matter, a lot. “Two households may have identical incomes, but they do not at all have identical capacity to pay taxes,” said Cristina Martin Firvida, AARP’s director of financial security. “And it’s not because of a choice that one of them made.”

Indeed, to critical observers, it looks like Republican leaders in Congress are using the tax code to punish states with high income taxes. They use the bill to accomplish this by limiting how much of those state income taxes are deductible. That effectively penalizes some of those residents, who did choose to live in those states, with a higher total tax bill.

Similarly, the proposal to lower the size of a mortgage that is eligible for interest deductions is akin to removing a subsidy for people who choose to buy bigger homes or live in more expensive areas.

Nobody chooses to be sick though, which makes the House’s move to strip out the medical expense deduction feel harsh to people who really, truly wish they had not qualified for it in the first place.