Old Age Is Expensive. For Women, It's a Crisis the Constitution Permits.
Here is who lives in American nursing homes: 70% are women. Here is who is 85 or older in those nursing homes: again, overwhelmingly women. Here is how most of them are paying: Medicaid — federal-state health insurance for people who have spent down their assets. And here is how most of them got there: they liquidated their savings, sold their possessions, and impoverished themselves to qualify. This is called Medicaid spend-down. It is not a bug in the system. It is the designed outcome.
The pathway is straight and well-documented. It begins with the wage gap — a lifetime of earning less than male peers. It continues through the motherhood penalty — career interruptions that reduce Social Security credits. It widens at widowhood — women outlive men by an average of five years and inherit the full cost of late-life care alone. And it ends in spend-down, which requires liquidating virtually every asset before public support kicks in.
Women who spent decades building assets lose them in the final years of their lives to a care system designed around the assumption that someone else would be paying.
The 2025 OBBBA cuts made this worse: an estimated $1 trillion in Medicaid reductions over ten years will fall disproportionately on elderly women in nursing facilities — the single largest category of long-term Medicaid recipients. These are not abstract budget numbers. They are cuts to specific, identifiable women whose poverty is the documented economic consequence of a lifetime without constitutional equality.
The ERA would not automatically fix elder poverty. But it would establish the constitutional foundation for challenging every policy that produces it — from Social Security formulas that penalize career gaps to Medicaid asset rules that treat women's lifelong savings as pre-payment for nursing care. Constitutional rights are the floor. They are what you fight from. And right now, women fighting for economic security in old age are fighting without one.
Women, The Economy and The ERA: Part 4 of 4
The Pay Gap Is Getting Worse. Here's the Math — and the Fix.
You're Penalized for Having a Baby. The Constitution Allows It.
Your Union Card Is the Best Pay-Equity Tool in America. For Now.
Old Age Is Expensive. For Women, It's a Crisis the Constitution Permits.
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Equal rights now means a more secure old age later. Sign the petition at Sign4ERA.org.