State Power to Protect Medicaid & Build a Caring Economy

State Power to Protect Medicaid & Build a Caring Economy

What is the Care Economy?

From childcare to elder care, to disability rights, to caring for those who are ill, we all provide care and are cared for. The care economy refers to the paid and unpaid work of caring for others. Though essential, the care economy is undervalued and underfunded. Care workers, predominantly women, Black, and immigrant workers, are underpaid and overworked. Care infrastructure, like hospitals, childcare facilities, and nursing homes are increasingly privatized and monopolized by big corporations and private equity firms. And care programs, like paid sick, family and medical leave, VPK programs, and medicaid, are hard fought, and under threat.

A robust care economy is a caring economy. It’s an economy that centers care for people and communities, versus an individual's profits. And it is possible. There are examples throughout history and across the world. At SiX, our team is working in collaboration with legislators and partners towards this vision in state capitols across the country – from legislation strengthening legal protections for breastfeeding parents and access to public buildings for people who are deaf & hard of hearing in Nevada, to organizing support to fund care infrastructure in Georgia, and everywhere in between, states are where we can make vision into reality. And in all 50 states, Medicaid is an essential part of our care economy, and facing direct threats. So how can states defend our wins towards building an inclusive care economy? Let’s dive in. 

Medicaid Works (that’s why it’s under attack)

We know that Medicaid works, transforming health care for low-income families and individuals, including children, parents, pregnant mothers, seniors, and people with disabilities since its creation in 1965. A jointly-state and federal funded program, Medicaid covers 1 in 5 people living in the United States, providing comprehensive coverage of health and long-term care to more than 80 million low-income people. In 2023, Medicaid covered nearly 4 in 10 children, over 8 in 10 children in poverty, 1 in 6 adults, and almost half of adults in poverty. Medicaid covers more than 1 in 4 adults ages 19-64 with disabilities, and provides coverage for 41% of all births. To date, 41 states (including DC) have expanded Medicaid, but nine states have so-called trigger laws that would automatically end Medicaid expansion if the federal government reduces their share. Overall, Black, Hispanic, and Native people, and rural communities would be hit the hardest by proposed cuts to Medicaid.

Understanding Our Opponents

Medicaid’s success is exactly why the ultra-wealthy want to dismantle it, and coordinated state attacks are not new. The Trump/Musk economic plan relies on tax cuts for the ultra-wealthy and a permanent, obedient underclass based on race, gender, and class. Programs like medicaid that effectively lift working families out of poverty threaten that plan and their power. That’s why Project 2025 and the congressional budget are targeting cuts to Medicaid to pay for tax cuts for the ultra-rich. Testifying before the DOGE subcommittee, Stewart Whitson of Foundation for Government Accountability made the clear:

A key source of wasteful spending that DOGE and the subcommittee should set their sights on next, and that's Medicaid waste and fraud. While initially meant as a program for the truly needy, Medicaid has bloated into a massive welfare program for millions of able-bodied adults lured into the trap of government dependency.”

A co-author of Project 2025, the Foundation for Government Accountability is the same billionaire-backed think tank behind countless efforts in states across the country to undercut direct democracy, roll back child labor protections, and dismantle essential support programs for working families including medicaid, food assistance, and unemployment insurance.

State Action to Protect & Expand Our Care

State legislators in all 50 states play an incredibly important role in protecting our care, and expanding it. Every state will have unique strategies, but there’s a few key considerations:

• Educate the public on the value of medicaid to your state. Georgetown University’s state-by-state snapshots are a great tool, and find messaging guidance below. President Pro Tempore Senator Dafna Michaelson Jenet and Assistant Majority Leader Senator Lisa Cutter took to the floor to do exactly that last week.  
• Connect real stories to the data. Storytelling is incredibly powerful. It helps bring data to life, and for others to see themselves in someone else’s shoes. Link the impact of Medicaid funding to real people in your district– on both the benefits of Medicaid and the harms if funding is lost. Ask constituents for consent before sharing stories.  
• Build an affirmative vision: States are the frontlines to create an inclusive care economy that benefits everyone. From medicaid expansion, paid family, sick, and medical leave, to state auto-IRAs, free childcare, child tax credits, and inclusion of immigrant families, states have an opportunity to not only defend essential programs, but demonstrate how government can deliver real, tangible gains for all working families. 
• Name our opponents: According to Navigator Research, nearly two in three Americans are concerned that Trump will give tax cuts to his billionaire friends at the expense of programs Americans rely on, and that billionaires are gaining too much power under his administration. This is exactly what is at stake – it’s important to say it out loud. 
• Work in collaboration with state advocacy efforts to protect our care. As a legislator, your sphere of influence is essential to state-based advocates working to protect medicaid. From congressional relationships, media engagement, hospitals and care providers, and constituent outreach and story collection, your contributions are essential. Not sure where to get started? SiX can help.

Messaging Guidance

Cuts to programs like Medicaid, Medicare and Social Security are the issue Americans are most concerned about. Keep the following messaging guidance from Navigator Research from February in mind:

• When communicating these sweeping executive actions, it’s essential that messengers clearly outline the human impacts of the Trump Administration’s latest moves to cut programs that benefit all Americans to enrich billionaires. Focus on the true victims of this decision – the people in your state losing healthcare coverage. 
• Medicaid and Medicare are places to take a firm stand. There is no public appetite for cutting Medicaid or Medicare. In our Navigator survey, 81% of Americans opposed any cuts to Medicaid. Similarly, 72% opposed cuts to SNAP and Head Start childcare funding. Put simply, Americans consistently reject slashing essential programs that people rely on to fund government handouts for billionaires and mega-corporations.
• Frame this as protecting programs Americans rely on. People do not like having things they rely on taken away, and when asked about budget priorities, 62% of Americans said it is more important to “protect important programs that Americans rely on,” while only 38% preferred cuts. Americans are under no illusion about who benefits from these cuts – most believe that the proposed tax plan is designed to serve the wealthy, with the rich and big corporations seen as the biggest winners 
• Tie these cuts to Medicaid to Trump’s plans to write a massive tax handout to the wealthy. The top concern in Navigator’s testing on Trump’s tax cuts was “Trump’s tax plan wouldn’t help middle and working class people struggling to deal with rising costs” with 32% finding the statement most concerning. Followed closely by “Trump's tax plan would cost the government billions and limit… programs like Social Security and Medicare” with 29% of Americans finding the statement most concerning. It is advocates’ job to make these seemingly disparate actions clearly connected.

Data & Research

• Medicaid State Fact Sheets (2024), KFF
• Medicaid: 50-State Snapshots (2025), Georgetown University 
• Policy Basics: Introduction to Medicaid, Center on Budget & Policy Priorities 
• 10 Things to Know About Medicaid, KFF
• A Medicaid Per Capita Cap: State by State Estimates, KFF
• Health Coverage by Race and Ethnicity, 2010-2023, KFF
• State Data Medicaid Coverage Rates for People Ages 0-64, KFF  
• Medicaid Cuts Hurt State Economies, National Health Law Program
• Medicaid’s Coverage Role in Small Towns and Rural Areas, Georgetown University
• Distribution of Certified Nursing Facility Residents by Primary Payer Source, KFF
• How Medicaid Supports Maternal and Infant Health, Georgetown University 
• State-by-State Analysis of the Who Lacks Access to Retirement Savings and the Potential Benefits of State-Facilitated Retirement Savings Programs, Georgetown University 
• The care economy is one of humanity's most valuable assets. Here's how we secure its future, World Economic Forum 

The Path Forward

We know Project 2025 began in the states. As we face attacks from all directions, it’s essential that we build an affirmative economic vision for the future in states, in collaboration with the communities most impacted by these cuts. SiX is working to organize partners in-state and across states in support of legislators defending care for all. If you need support, let us know.