Republican Sen. Joni Ernst is facing backlash after saying “we all are going to die” while talking about potential changes to Medicaid eligibility at a town hall in north-central Iowa.

She had been consistent in her message throughout the contentious forum at a high school in Parkersburg, Iowa, as she defended the tax and immigration package that has passed the House and is now under consideration in the Senate. Facing several constituents concerned about cuts to Medicaid, she defended the $700 billion in reduced spending, saying it would keep immigrants in the U.S. illegally and those who have access to insurance through their employers off the rolls.

Then someone in the crowd yelled that people will die without coverage.

“People are not … well, we all are going to die,” Ernst said, drawing groans. “So, for heaven’s sakes. For heaven’s sakes, folks.”