Troy Tassier is a professor of economics at Fordham University and the author of The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.

At first blush, I think about healthcare as a short-term tool. I’m sick with a fever and chills and I go get checked out by my doctor. Or I stop in for my yearly checkup and get some advice as I age a bit older every year (I keep waiting for him to tell me I’ve gotten younger but it hasn’t happened - yet). However, I’ve been lucky. I haven’t gone in and received a life changing or life threatening diagnosis that requires long-term treatment or care.

In addition to direct medical care, there are little pieces of advice that have accumulated over my life during these doctors’ visits like reminders to exercise, to eat many colors of vegetables, and to cut down on ice cream. Mostly boring stuff that I take in and let go a day or two later. It doesn’t seem like this advice accumulates but it does. The yearly reminders add up. They add up because I’m lucky to have an employer that provides high quality health insurance that allows me to see my doctor on a regular basis. Not everyone is so lucky. And, if your employer doesn’t provide health insurance, there’s a good chance that you can’t afford it on your own.

You may recall that I wrote about this last year almost to the day, May 3rd to be exact. I wrote about how the Governor of Mississippi, Tate Reeves, refused to expand Medicaid even though a majority of Mississippi citizens supported doing so. A majority of Mississippi’s elected leaders did too. However, they didn’t have enough votes to override Reeves’ veto. To Reeves Medicaid was welfare and he didn’t want to contribute to people being lazy. {insert eye roll}

Earners at the top rung of Medicaid expansion make $42,000 a year (if a family of four). These are people who work in restaurants and construction sites. Farms and factories. They work long hours, return home exhausted, and, despite their hard labor, they can’t afford healthcare. An average, non-subsidized health insurance plan costs over $17,000 per year for this family. This is more than 40% of their pre-tax income. Families making less than this are forced to pay even more as a percentage of income. These people are not lazy welfare queens and kings, as Ronald Reagan used to say. They simply can’t afford health insurance in today’s hyper-expensive world of US healthcare. And, not being able to afford health insurance will kill you. Literally.

A new study released this week by economists Angela Wyse and Bruce Meyer shows this exactly. The pair analyzed differences in mortality rates across states based on states that did and did not expand Medicaid as part of the Affordable Care Act and when the states that expanded did so. This allowed them to estimate the effect of gaining health insurance through Medicaid. Low income adults new to Medicaid had a 21% reduction in their risk of dying. There’s no understating it, that’s a big effect. Having access to health insurance through Medicaid saves lives and not having it kills.

The Federal government is about to be faced with a choice similar to the one Governor Reeves needed to make last year. Do we let the working poor have affordable health insurance or not? We know how they are going to decide, at least in part. Republicans are going to partially cut Medicaid. Their cuts to federal funding may trigger some states to un-expand Medicaid and lower the income limit to qualify. That $42,000 per year family will now be told to fund health insurance on their own and they can’t afford it.

Republicans like Reeves and many more see Medicaid as “welfare” and as a handout. They see it as undeserved and unearned. But why? How many people out there work a lot harder than a congressperson and earn less than $42,000 a year? How would they feel if it was their mother or brother or daughter or son that depended on Medicaid and someone took it away? Unfortunately, they don’t think in these terms. They think about cutting dollars and cents. They won’t think about other places to get the money, not even when there’s an obvious answer. Instead of cutting taxes for the wealthy, raise them. Elon Musk, Jeff Bezos, and Warren Buffet can afford it! They won’t miss a billion dollars less in their investment account. Buffet even alluded to the idea that more wealth for him isn’t good earlier this week, stating, “I’m not sure that the world will be better off if I’m richer.” He’s right. We’re not!

Congress, do the right thing. Do a better job managing the money coming in and you won’t need to sentence people to death. Literally.

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