It’s not hard to imagine what will happen if the federal government moves forward with a plan to cut about $1.5 trillion over the next decade from programs that provide health insurance and food supports to Americans who need it the most. The impact on people in every state will be immediate and severe. In a cruel twist, those “savings” would be used to fund a tax cut for Americans who have the most. This is the scenario the nation faces today.
Even as I write this, Medicaid and SNAP — programs that provide health insurance and food supports to tens of millions of people, saving lives and improving lives — are endangered. It’s unclear how much each program might be cut, or whether strict work documentation requirements will be enacted, or how this all will play out in the days and months ahead as Congress works toward a budget deal. But the threats are real and staggering.
There is much consternation today about how Americans — and philanthropies like the Robert Wood Johnson Foundation, which I lead — should respond in these moments of uncertainty. The Medicaid/SNAP fight is one of the latest, greatest threats, but surely not the last. So what should foundations and other nonprofits like ours do when bad things are happening to good and deserving people in such an aggressive and methodical way?
The answer is not just to fight for what’s right today — it means remembering that our core missions and values must not shift simply because the political winds have. In RWJF’s case, that means recommitting to building a future in which health is no longer a privilege for some, but a right for all. What that requires today is bold action that reinforces the work of others. Foundations like ours often ask our grantees and partners to take risks. In times like this, we must match their courage and take risks, as well. That means not just speaking up — which this foundation has been doing — but putting our money where our mouth is.
During the convergence of a pandemic five years ago and a brief period of reckoning with racism, RWJF realigned our budget and work with an increased focus on dismantling structural racism, the greatest barrier to health. These efforts are even more important today, as this work across the nation has been targeted and in many cases driven underground (see: DEI). The structural and strategic changes we made then have prepared us for times like these. We freed up more of our funds for both rapid-response communications (we do this through a grantee called Health Equity Works) and pro bono legal support through a partnership with the Lawyers’ Committee for Civil Rights Under Law. These are just two examples of what we’re doing, but it’s just the beginning of what we see as existential work.
Despite the increased scrutiny on foundations, we will not shy away from investing in addressing the real-time public health challenges that have become more acute in this climate, from reproductive justice to transgender health and disability inclusion. As the administration decimates our public health infrastructure, cuts federal funding and severely restricts access to health services, our mission becomes more critical than even just a few months ago.
One might expect that those of us at the nation’s largest health philanthropy would feel defeated given the political realities in Washington today. After all, we believe everyone should have access to high-quality, comprehensive, affordable healthcare. We believe the government should do more to support hardworking American families. We believe it is critical to invest in communities that have been left out of the American Dream at a time when many policymakers are abandoning the promise of America. We unapologetically maintain that structural racism and health are firmly connected and that the policies and practices that have created barriers for so many must be torn down to build something better. We have aggressively worked to expand Medicaid to the 10 holdout states that have not done so and have long been a vocal defender of SNAP, the Supplemental Nutrition Assistance Program, which helps feed 42 million Americans.
In short, we’re fighting for things that Americans want (and the polls back us on this), even if policymakers don’t see it this way.
As much as the Medicaid/SNAP fight is about politics, it’s also not about politics. Americans in every state, territory and tribal community stand to be affected by congressional actions. Medicaid cuts and SNAP cuts would not only reach the bluest states on our map. Red states, too, will feel the pain. In fact, rural communities stand to be bludgeoned by these cuts because Medicaid, along with the ACA marketplace, plays a disproportionately important role in such places.
A report in January from Georgetown’s Center on Children and Families found that 46 million people in small towns and rural communities are more likely than their urban counterparts to use Medicaid. The fallout from these cuts would also surely lead to more hospital closings, job losses and economic pain in already-underserved rural counties. These cuts will determine whether or not families can visit their doctors and receive the care they need and deserve, and they’ll force people to make impossible decisions about whether to pay the bills or to buy groceries for their children.
Philanthropy has an essential role to play in restoring our collective belief in what America can and should be — and RWJF is in this fight for the long run. Not the political fight, but a fight for people. Every American should have the right to live the healthiest life possible. Yet we know this reality will not be achieved in one calendar year, one election cycle, or even one decade. That’s why, together with our partners, we will fight in this moment, but we’ll not lose sight of our shared, long-term vision of a healthier, more equitable nation.
This is not just the right thing to do for America, but the patriotic thing to do. Nothing that has happened in the last few months changes that. We will continue to stand with our grantees, partners and philanthropic peers to accelerate the work to support the health of all people, the health of all communities, and the health of our democracy.
The greatest risk to the world of philanthropy today is not the actions we take, but the ones we don’t.
Richard E. Besser, MD, is president and CEO of the Robert Wood Johnson Foundation (RWJF), and has served as interim director of the Centers for Disease Control and Prevention and the chief health and medical editor for ABC News. At the Robert Wood Johnson Foundation, Rich leads the largest private foundation in the country devoted solely to improving the nation’s health.
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