The cost of fixing the nation’s widening affordable housing shortage measures in the billions of dollars. But if the healthcare costs that come with this lack of housing security are factored in, replenishing and expanding our low-income housing stock becomes an even better investment.

During a press call about The Gap—the National Low-Income Housing Coalition’s annual report on the state of the nation’s housing—Diane Yentel, president and CEO of the NLIHC, described a situation at a breaking point.

Today, more than 8 million Americans spend more than half their income on housing, meaning that these severely rent-burdened households have little left every month to pay for food, transportation, and healthcare. No state or city in the entire country has an adequate supply of housing for extremely low-income housing population; California alone is short one million units.

The political responses to this crisis couldn’t be more opposed. The Trump administration, in its latest budget proposal, suggests slashing funding for the Department of Housing and Urban Development (HUD) by more than 16 percent, with those cuts affecting public housing and the maintenance and improvement of public housing buildings, and wants to add work requirements to existing programs.

At the same time, according to Yentel, the housing programs proposed by Democratic presidential candidates such as senators Elizabeth Warren and Kamala Harris offer bold solutions, “the likes of which, in scale and scope, we haven’t seen in decades.”

“We have the resources, but lack the political will,” Yentel added.

The health care costs of inadequate housing

The gaps in available housing for extremely low-income Americans—defined as a family of four making $25,750, or 30 percent of the area median income, whichever is greater—continue to grow. Only 37 of 100 rental units across the nation are available for extremely low-income renters, 48 percent of whom are seniors with disabilities. Across the country, the supply of units for extremely low-income renters decreased 7 percent in 2017 alone.

In many growing metro areas, the situation is much worse. Houston, Los Angeles, Las Vegas, and Orlando all have less than 20 affordable and available rental homes per 100 rental households.

This pressure saps the ability of low-income families to do anything beside pay rent and keep their heads above water, according to the report. For instance, a severely cost-burdened extremely low-income family of four with monthly income of $1,839, will, after paying for an average two-bedroom apartment at fair market rent, only have $690 left over to pay for everything else, including food and medicine.

This widening gulf between needed and available housing extracts a significant toll on the health and well-being of renters, increasing rate of food security and poor nutrition, and delaying care.

According to Dr. Megan Sandel of the Boston Medical Center, the long-term health care costs of unstable housing is $111 billion over an entire decade. That figure includes $76.8 billion in maternal health issues, including depression for anxious mothers, and $34.3 billion in child health care costs.

“We often talk about the gaps in housing funding, but what we don’t acknowledge is that we’re already paying so many additional health care costs,” says Sandel.

Stable and supportive housing, or the lack thereof, can make a stark difference. A recent Oregon study found that when residents obtained subsidized and affordable housing, emergency room visits decreased by 18 percent, Medicaid expenditures decreased by 12 percent, and their visits to primary care doctors increased by 20 percent.

Existing federal housing programs, which the White House wants to trim or cut, already don’t rise to the challenge of providing all Americans with affordable housing. According to the NLIHC, federal programs today serve roughly 5 million U.S. households,

“Only one in four families in need receive the assistance they require,” says Yentel. “Those who get subsidies are the lucky ones.”

Presidential candidates pushing for change

The country has the resources, but lacks the political will to enact housing reform, or spend enough money on programs like Housing Choice Vouchers or expanding the housing trust fund, to significantly close the gap. Existing public housing, often aged and in a state of disrepair, faces a $53 billion repair backlog.

And the private sector isn’t building the affordable units this crisis requires. According to Harvard Joint Center for Housing Studies data, the average rent of a new apartment building in 2017 is $1,550, more than twice the rate considered affordable for an extremely low-income renter.

But advocacy groups and the current field of Democratic presidential candidates has elevated affordable housing and made it a significant campaign issue, among larger discussion about inequality and economic fairness.

Both Senator Warren and Senator Kamala Harris, two leading candidates for the nomination, proposed housing bills last fall. Warren’s plan, the American Housing and Economic Mobility Act to the House, would create three million new housing units, improve access to affordable housing through anti-discrimination laws, and invest in families living in historically redlined communities. Harris’s proposal, the Rent Relief Act bill, would grant renters a credit for any rent costs above and beyond 30 percent of their annual income.

While these proposals seem impossible to enact in the current era of divided government, Yentel praised the increased awareness of the issue and the realization that rhetoric needed to be backed up with new investment.

“One way or another we pay for the housing crisis,” Yentel says. “Inaction is expensive.”