One of the main things that separates Republican politicians from Democratic ones these days is that the Democrats seem to still care whether people live or die. Not so much the Republicans. The fact is that the way Donald Trump and the Republicans are slashing vital government programs will inevitably result in the deaths of tens of thousands of Americans — and many more abroad.

Let’s start with the obvious: if you take away health care from people, more of them will die. Consider Medicaid. The current Republican bill will put stiff restrictions on who can use it, and will likely result in denying medical insurance to at least 8.6 million people, according to the Congressional Budget Office. The Center for American Progress believes that figure will be much higher — closer to 15 million people who will have no health insurance. If so, the estimate is that this would cause over 49,000 deaths every year. It makes you wonder who could vote for these kinds of inhumane cuts.

Or take vaccines. Trump has cancelled funding for studies on how we can increase immunization rates. Also, Robert F. Kennedy Jr. and others in the administration have made comments that will discourage people’s participation in the federal childhood vaccination program. During the last 30 years, this vaccination program has prevented 1.1 million childhood deaths — and averted 32 million hospitalizations and saved an estimated $540 billion. The Republican-encouraged anti-vax movement will likely result in thousands of preventable child deaths. Last year alone, the CDC reported 200 pediatric flu-related deaths, the highest numbers since the 1990s. Of those deaths, about 80% were in children who were not fully vaccinated. Worse is sure to come.

Or consider OSHA — the Occupational Safety and Health Administration. According to the Economic Policy Institute, since its inception OSHA has saved an estimated 712,000 lives and workplace fatalities have gone down by almost two-thirds — even as the size of the American workforce has doubled. But the Republicans aim to put a stop to this. Republican Arizona Congressman Andy Biggs has introduced legislation to abolish OSHA. And Trump already has been shutting down OSHA offices and cutting back on OSHA enforcement efforts. He also wants OSHA to eliminate 10 existing workplace safety regulations for each new one they create. More accidents and fatalities are inevitable.

Also, we tend to forget the U.S. environmental laws not only protect nature, but also save human lives. The EPA estimates that the Clean Air Act and its amendments alone have saved millions of American lives since 1970, and continue to prevent over 230,000 premature deaths annually. Nevertheless, Trump and his EPA director are planning the biggest rollback of environmental rules in our history. The Environmental Protection Network, a group of former EPA staffers and officials, has estimated that Trump’s undermining of clean air rules would result in 200,000 premature deaths by 2050.

If we turn to American foreign aid, the results are even more grim. For example, Trump has significantly cut back on the efforts of USAID’s PEPFAR program — started by President George W. Bush to address the ongoing world-wide AIDS epidemic. The Kaiser Family Foundation has estimated that a 90-day pause in this program will result in 100,000 excess HIV-related deaths in Sub-Saharan Africa. And if this program is canceled, it could result in nearly 3 million additional AIDS-related deaths by 2030 across 26 nations.

Trump also has withdrawn the U.S. from the Paris Climate Agreement, suspended research on global warming, cut $15 billion from clean energy projects, and promised to boost the use of fossil fuels, all of which will accelerate warming. A study by the World Economic Forum forecasts that by 2050, unchecked global warming could lead to 14.5 millions deaths, mostly from increased floods, droughts, heat waves, and mosquito and tick borne diseases. Republican actions are clearly contributing to this death toll.

Of course President Trump and the Republicans in Congress would prefer that no one point out the deadly consequences of their policies. They want us to believe that taking an ax to vital government programs is only about “efficiency” and “cutting waste.” But make no mistake: lives are at stake and lives will be lost. We all need to keep that in mind when we next go to the polls.

Douglas J. Amy is a professor emeritus of politics at Mount Holyoke College. He lives in Northampton.