Anna Wadia: Saving Medicaid – and Our Democracy

By Anna Wadia

We are at a historic and existential moment in our country’s history. The 2025 tax and budget debate will test our country’s values and priorities, determining the kind of society we will live in and how each of us will contribute to its realization.  If massive tax cuts for wealthy individuals and corporations are funded by deep cuts and structural changes to vital programs, the impacts will span generations, reversing gains for women, children, older adults, people with disabilities, and workers.

The ultimate result will be a wealth transfer to the rich that deepens inequality and leaves families with little more than empty promises. If ever there was a moment for groups across a wide diversity of causes to join forces, it is now. 

As a funder of the care movement for the last three decades, I am disheartened by how lawmakers are putting partisan interests ahead of the needs of our communities.  A prime example is Medicaid.  Medicaid plays a crucial role in supporting the care economy, from providing long-term care for older adults and people with disabilities to funding essential health services for children and mothers.  Last month’s shutdown of Medicaid’s portal foreshadowed looming plans by the current Administration and Congress to use Medicaid as a piggy bank to pay for tax cuts for the ultra-wealthy.  This should worry us all.

Medicaid provides care across the lifespan, from birth to old age.  As maternal mortality ravages women–especially Black and Indigenous women–and reproductive freedoms face grave threats, divesting from Medicaid will deepen the harm impacting women and infants.  Medicaid covers 41 percent of all births.  It also provides health insurance for 40 percent of children, including crucial health and developmental services for children with disabilities.  

For older adults and people with disabilities, Medicaid is the largest funder of long-term care services, helping prevent unnecessary institutionalization and enabling people to live at home, with or near their loved ones. Slashing Medicaid financing will exacerbate the workforce shortage in the care sector, making it harder for older adults and people with disabilities to find and retain the care they need to live independently with safety and dignity. If the Federal government stops paying its fair share of Medicaid benefits, states will not be able to make up the difference and millions will go without the care they need. These decisions will be felt in every community, at every kitchen table, across the nation.

No wonder the majority of the U.S. population wants to keep or expand Medicaid.

We all have a responsibility to carefully consider the impact of these regressive tax giveaways, and philanthropy in particular has a critical role to play.  Protecting Medicaid and other intergenerational programs will require a cross-issue, cross-generational movement–the exact type of movement that the Care for All with Respect & Equity (CARE) Fund has been fostering. Whether a foundation or individual donor focuses on birth equity, children, older adults, people with disabilities, workers’ rights, reproductive rights or other healthcare issues, this is mission critical.  

In anticipation of this year’s federal tax and budget negotiations, the CARE Fund has been resourcing the care movement to fight for tax equity and collaborating with the tax equity movement to prioritize care investments. What we need–and what the public overwhelmingly supports–is exactly the opposite of huge tax giveaways to the ultra-rich.

The long-term goal is to increase revenue by making everyone pay their fair share of taxes, allowing us to invest in the child care, paid leave, and aging and disability care we all need. Groups such as Caring Across Generations, Family Values @ Work, MomsRising, the National Domestic Workers’ Alliance, and the National Women’s Law Center have been mobilizing care workers, parents, people with disabilities, older adults and family caregivers to secure this public investment in care and protect vital care services. 

We know that when advocates unite across movements, they can deliver meaningful change. In 2017, disability rights groups like Little Lobbyists and The Arc built a powerful coalition of organizations representing older adults, low-income families, and people with disabilities to successfully protect Medicaid from cuts tied to dismantling the Affordable Care Act. 

By advocating with their disabled children at their side, Little Lobbyists families humanized Medicaid, highlighting how it enabled them to live joyful lives with dignity and independence. Similarly, The Arc mobilized children and adults with intellectual and developmental disabilities to tell their stories about how Medicaid has empowered them to attend school, secure a job, and live in their own home.

The CARE Fund and other foundation partners were pivotal in supporting the growth of these organizations, which are now reuniting stronger than ever. Disability rights groups are joining forces with advocates for children, older adults, women, care workers, and many other communities to defend Medicaid and advocate for raising revenue to expand and improve our care programs. 

For the sake of our communities and our very democracy, we are at an all-hands-on deck moment that requires the full involvement of foundations, organizations, and individuals. By uniting around fair taxes and a federal budget that puts families and communities first, we all can help safeguard Medicaid and other programs that improve lives, and lay the groundwork for future investments in the care we all need and deserve. 

Anna Shireen Wadia is the executive director of the Care for All with Respect & Equity (CARE) Fund.