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A new study by the Center for American Progress published today found that expanding Medicaid in the states that haven’t yet done so “would save more than 14,000 lives per year.” This means that, without expanding Medicaid, 14,000 people may die unnecessarily, because of political choices made by Republicans.

Other life-changing and life-saving benefits of expanding Medicaid in those states would include more than 5,000 early cancer diagnoses and 1,517 bankruptcies prevented, the report found. A 2017 study by the National Bureau of Economic Research found that Medicaid expansion overall prevented 50,000 bankruptcies.

The CAP study also estimates that 141 infants’ lives would be saved, building on existing research showing that infant mortality went down by more in states that expanded Medicaid. In fact, a plethora of existing studies have already confirmed that Medicaid expansion has specifically served “vulnerable populations,” according to the Kaiser Family Foundation, including people with HIV, low-income workers, and parents. Most research, KFF wrote in March, “demonstrates that Medicaid expansion has positively affected access to care, utilization of services, the affordability of care, and financial security among the low-income population.”

The number of lives saved by Medicaid expansion could be even higher, too. The report said the author based her findings on a 2017 study that “estimated that one additional life was saved each year for every 239 to 316 adults who gained insurance,” but used the more conservative end of that estimate, one life per 316 individuals. If it was closer to the other end of that scale, at one life per 239 individuals, the number of lives saved by expanding coverage could be even higher.

The importance of a study like this cannot be overstated, both in policy and political terms. Democrats can reasonably and accurately say that Republicans’ failure to expand Medicaid might kill 14,000 Americans, 141 babies. Democrats can reasonably say that there is blood on the Republicans’ hands. It isn’t uncivil or “playing politics” to say this. A policy decision made by Republicans prevents millions of people getting the necessary healthcare, which they would otherwise have, meaning when they get sick they can’t get treated, or they get treated too late, and they die. There’s nothing wrong with saying that; in fact, if you don’t say that, you are letting down the people affected, who are broadly the people with the least voice in our failing democracy.

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I think about this 2016 piece by Texas-based reporter Chris Hooks at least once a week, which summed up this concept better than I could:

Nineteen states, including many of the country’s poorest, still haven’t taken money to expand Medicaid. It is somehow considered unchill to point out that this is a decision that has a death toll, but it does. But just as much, it means a lot of poor people living in pain, with ailments that are manageable or preventable: The difference between diabetes medication and an amputated foot.

That’s what politics is — the way we distribute pain. It’s not a sport or a fraternity or a game. It’s how we determine who gets medication and who dies young, who learns in a class of twenty kids and who learns in a class of thirty, whose school has a counselor that’s trained to look for signs of sexual abuse and who doesn’t.

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Who gets healthcare is, more than most other areas of policy, a matter of life and death. Republicans have chosen to side with death.