How are you getting $166k take home for a $200 salary? If I use one of those online tax calculator things for New York, I get a take home of $135,000 from $200k. Ok, so let’s try a lower tax state that still has a lot of economic opportunity. For Texas I get $150,000 take home. Once you start adding on the costs associated in the US with having a serious medical condition, it’s far from clear that you’re going to be saving a lot of money from lower taxes. You’ll save a bit if you stay healthy and pay a lot more if you don’t.