I’ve been digging into the implications of the reconciliation bill that was signed into law this July, and I need to share what I’ve learned with our community. Amanda and I discussed this in more detail on the latest episode of the Fundraising HayDay podcast. This isn’t just another policy change we can ignore or hope that it goes away. It’s going to fundamentally alter the landscape we work in.
The numbers are staggering. We’re looking at 17 million people losing healthcare coverage, primarily through Medicaid cuts. These aren’t young, healthy adults who rarely need medical care. Research shows that four out of five people at risk are deeply impoverished women with an average age of 41, and one in four are over 50. When they lose coverage, they’ll turn to the nonprofits and local government agencies many of us serve. And you are going to be pressed to raise more money and win more grants.
The economic ripple effects will be severe. George Washington University researchers project nearly 300,000 job losses, with half being healthcare workers. State economies could contract by $34 billion just from lost marketplace subsidies. Add in SNAP benefit cuts, and we’re facing a perfect storm of increased demand for services while funding sources shrink.
Speaking of funding, corporate giving is expected to drop by $4.5 billion annually due to new charitable contribution floors and caps on itemized deductions for high earners. For those suggesting we simply “pivot to private foundations,” I need to be clear: that means more competition, smaller grants, and fewer opportunities overall.
First, collect baseline data on your current service levels and client demographics. Document your partnerships with healthcare providers—you’ll need this information to make compelling cases to funders.
Second, start building relationships with hospitals and community health centers. They’re facing enormous pressures and could become valuable partners.
Third, diversify your fundraising strategy beyond grants. The 2024 Giving USA report shows grants are just one piece of the funding puzzle, and those relying solely on federal grants are extremely vulnerable.
Finally, invest in data collection systems to track the connection between policy changes and service demand. You’ll need this documentation to demonstrate impact to boards and funders.
This isn’t a temporary disruption—it’s a long-term shift that will unfold over months and years. But by preparing now and working together, we can better serve our communities through what’s coming.
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