A full-blown humanitarian crisis is still underway in Puerto Rico after Hurricane Maria devastated the island last month. More than 80 percent of the island is still without electricity, there’s a daily shortage of 1.8 million meals, and hospitals are running low on medication, according to the Federal Emergency Management Agency. In California, uncontrollable wildfires continue to ravage homes and entire economies. People are dying.

The House passed an emergency relief package this week that would direct $36.5 billion toward recovery efforts in Puerto Rico, California, and other communities affected by natural disasters. But 69 Republicans voted against it.

The excuse: It would be too big a blow to the deficit.

“Up here we use these casual phrases that we are going to write off the debt,” Rep. Dave Brat (R-VA), who voted against the relief package, told reporters. “Whoosh, there it goes. But where does it go? It goes to the taxpayer.”

Brat — like many of his conservative colleagues in the House Freedom Caucus who voted against the aid — said he wanted to see ways to offset the cost of these supplemental relief packages. Those demands, which range from reforms of the National Flood Insurance Program to proposals that slash social safety net programs — would take time, and leave people already in life-threatening situations hanging.

But this wrenching concern over the deficit — particularly when the situation in Puerto Rico remains so dire — is hard for some to swallow when conservatives are simultaneously pushing forward a tax reform package that could leave a more than a trillion-dollar hole in the deficit and have signed on to spending bills that added more than $100 billion to defense spending, without the immediate promise of offsets elsewhere.

But the conservative line in the House doesn’t seem fazed by such dissonance.

“My whole thing is that if it’s emergency funding, then historically we need to look at what we do with FEMA and properly fund it,” Rep. Mark Meadows (R-NC), who also did not vote for the aid package, said. “FEMA is for emergencies. Why have FEMA there if you are going to have supplementals all the time?”

Those considerations were not raised during the House’s appropriations process, which allocates money to federal agencies like FEMA — which the House Freedom Caucus overwhelming supported.

Even so, fiscal hawks are quick to raise concerns over supplemental spending requests — even emergency relief ones. Last month Congress passed a $15 billion relief package for Texas and Florida after Hurricanes Irma and Harvey, tying it to a three-month debt ceiling raise and stopgap funding measure to keep the government open. At the time, 90 House Republicans and 17 Senate Republicans voted against the package — citing the deficit, and that the relief aid was tied to the debt ceiling and continuing resolution proposal.

“Hurricane aid shouldn’t be added to the debt,” Rep. Mark Walker (R-NC) opined in the Wall Street Journal this week. “That’s akin to going to the Emergency Room after an injury, putting the charges on a credit card, and then pretending that the Visa bill is never going to arrive.”

For those hoping for relief in Puerto Rico, the hypothetical Visa bill is far from an area of concern. They’re just awaiting electricity, food, and water.