Two crises are converging in health care that will make life much worse for Americans. As a physician, I see them colliding in my patients — and I am both heartbroken and furious. On Thursday, as the covid-19 pandemic claimed its 122,000th American life, the Trump administration filed a brief to the U.S. Supreme Court, effectively seeking to eliminate the Affordable Care Act, which could take health care away from 23 million people.

Trump himself later tweeted, “many States & the U.S. are asking the Supreme Court that Obamacare itself be terminated so that it can be replaced with a FAR BETTER AND MUCH LESS EXPENSIVE ALTERNATIVE.” No such alternative was in the offing. It is an effort that will put all of us at risk, potentially exposing more people to covid-19 and putting those with other preexisting conditions at even greater risk.

I know this because I know all too well how patients without insurance go about their lives when they are sick and how they often end up making themselves sicker. Back on Thursday, a patient with a history of cancer came to my emergency department with pain in her throat and fear and weariness in her eyes. She came reluctantly, she said, having put off the visit off as long as she could until she could not bear the pain any longer. She had no health insurance, and she was afraid she would wind up with thousands of dollars in new medical debt. She told me she had gone years without getting any tests or seeing a doctor. To save money, she said.

A CT scan showed she had a likely mass. I wanted to have her transferred to a larger hospital with more resources, but she had to leave. Like countless patients I see in my critical access safety net hospital in rural Michigan, she had bounced around from one low-wage job to another, cobbling together a living. She said she was starting a new job and did not want to miss a day. She said the job might lead to health insurance and, briefly, she lit up.

Her optimism could not hide a simple fact: Had she received regular tests and checkups, she would not be where she was, seized once again by what was likely cancer in an advanced stage. Even as I tried to talk her through some next steps she should take, she was rushing out the door, trying to get to her new job on time, because without paid sick leave, her medical emergency was just another workplace no-show, a demerit that could get her fired.

These are the queasy choices that my patient — and tens of millions of Americans like her — face every day. Get a checkup or spend the out-of-pocket money on food. Take care of cancer now or delay it for a job that does not let them take time off. Go to the ER or pretend the searing pain in the chest is just heartburn that will pass.

Around 30 million Americans are already uninsured to begin with. Trump is cutting even more, without a plan to replace the ACA. In the past two months, 22 million more lost their jobs — and for many of them, their employer-provided health insurance — because of a nosediving economy Trump left defenseless against covid-19. His reckless effort to eliminate the ACA now could also take away health care or raise costs for 130 million Americans with preexisting conditions, and the consequences for people during this pandemic will be far-reaching and dire.

With covid-19, the heartbreaking bind in which these patients find themselves is only magnified.

Patients with classic symptoms of covid-19 too often come in late, thinking they can ride out a fever only to stumble into the ER gasping for air like fish on a dock. By then, their condition has worsened. They have exposed friends and loved ones to the coronavirus. Those people may have exposed more people. Some of them might have a history of cancer, like my patient with the mass in her throat, or diabetes, from which 1-in-3 Americans suffers, or heart disease, the leading cause of U.S. deaths, and which are all conditions likely to make covid-19 more lethal. If they survive covid-19, the end of the ACA could allow insurance companies to deny them health care, citing preexisting conditions resulting from covid-19-related complications such as stroke and chronic lung disease.

Now, in the middle of a pandemic that is killing hundreds of Americans a day, Trump and Republican attorneys general in 18 states want to take away the security and protection of health care from millions of people. Too many will suffer if they succeed.