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As the president of Voices for Progress, I work with a national network of business owners, entrepreneurs, philanthropists, prominent leaders, and, most importantly, taxpayers who believe that our economy should work for everyone, not just the wealthiest few. This is remarkable because they are personally among those wealthiest few. Rather than supporting economic policies that minimize their own taxes as much as possible, they have spoken out in support of increasing their own taxes for the good of the country.
Right now, the impact is unmistakable. Republicans’ decision to let the enhanced Affordable Care Act (ACA) premium tax credits expire has already put more than 4 million Americans at risk of losing coverage, and, alongside Medicaid cuts, would leave an estimated 16 million people uninsured by 2034.
The 2017 Trump tax cuts worsened an already unequal system. This past summer, the so-called “Big Beautiful Bill” exacerbated many of those same inequities. Before these changes, the wealthiest Americans paid much higher effective tax rates. Today, their real tax burden has decreased even more, costing our country billions in revenue that should be invested in schools, housing, child care, health care, clean energy, and infrastructure. Meanwhile, the corporate tax rate dropped from 35% to 21%, yet many major corporations still pay far less or nothing at all.
The results are staggering. Since those tax cuts passed, in just eight years, America’s billionaires have nearly doubled their combined wealth. Meanwhile, millions of workers are still struggling to cover the basics: rent, groceries, and basic health care.
This isn’t just an economic imbalance; it’s a moral and democratic failure. Extreme wealth hoarded at the top doesn’t circulate through local businesses, support public services, or strengthen communities. It turns our economy into a zero-sum game, where wealth is concentrated at the top, and comes at the expense of everyone else.
We’ve seen how this inequality plays out in real time. The so-called “Big Beautiful Bill” is already having devastating consequences for health care access and affordability. As its provisions take effect, families are facing higher health insurance premiums, reduced coverage options, delayed care, and mounting medical debt. Hospitals and clinics — especially in rural and underserved communities — are being pushed to the brink, forcing cutbacks that leave patients with fewer providers, longer wait times, and millions in care deserts.
The bill exposes a harsh reality: when Republican lawmakers prioritize tax breaks and giveaways for the wealthy, everyday Americans pay the price with their health.
Why are everyday Americans being asked to shoulder such a crushing burden to benefit billionaires and multi-millionaires? Instead, health care supports should be restored and strengthened so families can afford coverage, access timely care, and avoid crushing medical debt. That means fully funding programs that lower premiums and out-of-pocket costs, protect coverage for people with preexisting conditions, and sustain hospitals, clinics, and providers — particularly in rural and underserved communities.
To make these investments possible, the very wealthiest should be paying their fair share, ensuring that our democracy’s essential health programs are funded not by cuts to care, but by a tax system that reflects shared responsibility and economic fairness.
A proposal from the Tax the Greedy Billionaires coalition, of which Voices for Progress is a part, known as the “Five and Dime” tax, would take a meaningful step toward correcting this imbalance. It would impose a 5% annual tax on wealth over $50 million and 10% on fortunes above $250 million, potentially raising an estimated $6.8 trillion over the next decade.
This type of solution will slow the rapid rise of billionaire wealth, limit the influence of inherited fortunes, and give the next generation a real chance to build stable, secure lives. Policies like these will promote fairness and shared opportunity.
Americans aren’t asking for a system that punishes success. They want a system where success is not just for a small group of people who have every benefit extended to them. Instead, everyone should contribute their fair share to the country we all live in and depend on.
We stand at a crossroads: we can maintain a tax code that concentrates wealth and starves our health care system of needed resources, or we can choose one that supports our communities by funding affordable coverage, stable providers, and quality care for all of us. This isn’t just a debate about taxes. It’s about whether our health care system is strong enough to show up for people when they need it most — and whether our system of governance reflects that commitment.
Sandra Fluke is the president of Voices for Progress (V4P), a national network of wealthy leaders and philanthropists who unite to champion a healthy climate and environment, strengthen our democracy, and ensure economic and social justice for all.
