As a stage 4 cancer survivor, I know a thing or two about being sick. But if Republican legislators and governors refuse to take free federal money that pays for health care to their poorest constituents, it’s their ideology that is truly sick.

The Affordable Care Act was designed to cover low to middle-income Americans with affordable health insurance, including self-employed people like me who cannot get decent insurance any other way.

As a part of the original law, Americans with the lowest incomes would use an expanded government Medicaid program for health care, and everyone else would be covered by the Affordable Care Act’s private insurance. But after a 2012 Supreme Court ruling, states were no longer required to expand health care to their poorest citizens through Medicaid.

Some Republican governors and state legislators seized upon this decision to leave millions of their constituents without access to affordable health care. The neediest Americans received no ACA tax credit subsidies, making those insurance policies too expensive to buy. These citizens were not eligible for Medicaid either.

To fill this gap, President Joe Biden’s American Rescue Plan includes financial incentives to holdout states to finally expand Medicaid. Up to 4 million low-income Americans could get covered with cheap or free health care if their states took action. Financial help from the government would more than cover the cost of expansion. States would actually make money if they accepted it.

It should be a win-win for states. And yet, here we are.

State legislatures in Georgia, Florida, Mississippi, South Dakota, and Wyoming have already adjourned without taking action to expand Medicaid. It appears that Texas also won’t expand the federal health program. It’s quite possible that state legislatures in all 12 holdout states (Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, South Dakota, Tennessee, Texas, Wisconsin, and Wyoming) will refuse to act this year. In Missouri, which already voted for expansion via a ballot initiative, Republican legislators are ignoring the will of the people and are refusing to appropriate money for the health care that Missourians voted for.

Health care for Americans is a popular and bipartisan issue. Even in the reddest states, people have voted repeatedly, by large margins, to expand health care to low-income families. The Affordable Care Act was even based on ideas developed by the conservative think tank Heritage Foundation, and included in the health insurance plan enacted by Mitt Romney, the Republican former governor of Massachusetts.

But health care in general and the Affordable Care Act in particular have become targets of a negative crusade for many elected Republicans. They have chosen to harm the neediest and most vulnerable in order to score political points on Fox News and with the right wing.

When I was diagnosed in 2017, I found myself fighting cancer at the same time as I was fighting to keep my insurance. The day after my first chemotherapy appointment—four years ago today—Republicans in the US House voted to dismantle the Affordable Care Act, which was keeping me alive. I went through chemo session after chemo session, speaking out at rallies and events begging my Republican senator, Dean Heller, to listen to our pleas and save our care. He did not listen. But thanks to Senator McCain’s crucial vote, the overt attacks stopped that summer.

The Affordable Care Act was saved by his single vote. It never should have been that close.

Isn’t the fundamental duty of an elected official to keep their constituents healthy and safe? What happens when nearly an entire political party prioritizes keeping wealthy donors happy and frustrating liberals over the health of their people?

Yes, free federal dollars cost money to someone, eventually. But Republicans as a party voted in lockstep for Trump’s tax cuts for wealthy individuals and corporations without worrying about the fiscal consequences. It’s a little late to be concerned about future budgetary issues, when right now the health of their own constituents is directly at stake.

In the midst of a pandemic, the Republican Party has lost its way. Instead of working together with Democrats on expanding health care and tackling the infrastructure investment our country needs, it focuses on voter suppression so Republicans will no longer need to answer to majority voices.

Lives truly are at stake. Republicans in those 12 non-expansion states can either vote for the health of their constituents or not. So far, they are choosing indifference to poor and sick constituents. As Joe Biden put it in his speech before Congress last week, “Health care should be a right not a privilege in America.”

Voters who care about health care—and polls show that’s a majority of us—are watching. Next election, we’ll remember.