In May 2025, the US House of Representatives passed the reconciliation package, the One Big Beautiful Bill Act. To offset the cost of trillions of dollars in tax cuts, the bill includes more than $880 billion in spending cuts (PDF), including $790 billion in cuts to Medicaid.
These changes would significantly reduce health care access for people with low incomes nationwide. Many of the roughly 3 in 10 young adults ages 18 to 24 insured through Medicaid could lose coverage.
As Congress considers cuts to Medicaid, policymakers could consider how young adults’ access to health care and ability to transition into adulthood could be affected.
Medicaid supports the healthy development of almost one-third of young adults
Though young adults are generally healthier than the overall adult population, they have reproductive, mental, and behavioral health needs that make accessing care vital. And establishing healthy habits can prevent health problems.
Research has shown that Medicaid coverage supports access to health services, helps stabilize beneficiaries’ finances, and can reduce mortality among younger adults.
Becoming self-sufficient can be challenging for young adults, who are more likely than other adults to work low-wage jobs, work in the gig economy (PDF), or be unemployed. As such, safety net programs like Medicaid can help young adults with less familial support successfully transition to the workforce and set them up to thrive in the long term.
Research suggests that Medicaid enrollment leads to higher average earnings as adults. In other words, young adults who receive Medicaid are likely to return this investment in their health to society by paying more taxes as adults.
How Medicaid cuts could negatively affect young adults’ development
If passed by the Senate as written, the One Big Beautiful Bill Act would cut Medicaid benefits in several key ways that could disproportionately affect young adults’ access to health care. Though the proposals involve complex or technical program changes with less-than-obvious implications, they would have a clear effect on young adults’ lives.
Here’s how some of the changes to Medicaid in the House bill could affect young adults in the short and long terms:
Raising out-of-pocket costs could threaten young people’s access to care. In states that expanded Medicaid through the Affordable Care Act, adults with low incomes (at or below 138 percent of federal poverty guidelines) can qualify for the benefit based on income. However, the House bill would require adults who qualify for Medicaid through the expansion and have incomes over 100 percent of the federal poverty level to share more of the cost of their care.
Research has shown cost sharing in Medicaid leads to worse access to care and increased financial burden among beneficiaries. Medicaid expansion is a key source of health coverage among young adults, meaning they will be disproportionately affected by this change.
Increasing application and other paperwork requirements would disproportionately reduce young adults’ access to Medicaid. The bill includes several provisions that would make it more difficult to apply for and maintain Medicaid coverage.
One proposed change would require states to conduct eligibility checks for people covered under the Medicaid expansion every 6 months—up from the 12 months currently required. It would also reverse course on a rule finalized under the Biden administration designed to make it easier for people to enroll and maintain Medicaid coverage.
Research shows young adults struggle more than older adults to successfully navigate bureaucracy because they lack experience, face challenges engaging agency staff, and have difficulty gathering required documentation and completing paperwork. Given that many young adults are covered under the Medicaid expansion, they would be particularly hard hit by doubling the frequency of eligibility checks for the expansion population.
- Address-verification requirements would be difficult for young adults to navigate, given they are more likely to move than older adults. Under the proposed bill, states would be required to regularly obtain beneficiaries’ addresses to prevent enrollment in multiple states. In practice, address verification would mean states could disenroll young adults who remain eligible for Medicaid but do not update their address.
Work-reporting requirements could lead more young adults to lose coverage even if they are working. Congress is considering conditioning Medicaid coverage on whether beneficiaries report their work hours. In the House bill, able-bodied adults without dependents would be required to demonstrate they are working, completing community service, or participating in a work program for 80 hours per month starting in 2026.
A recent Urban Institute analysis showed that similar work requirements in Arkansas did not lead more recipients to work. Instead, enrollees had difficulty meeting the burdensome reporting requirements. The work requirements also led to delays in medical care and increased enrollee medical debt. Because young adults often struggle to navigate bureaucracy, they are particularly vulnerable to losing Medicaid coverage under the new requirements.
Proposed Medicaid changes would likely reduce young adults’ access to reproductive care and other critical health services. If passed, the bill would prohibit Medicaid from covering services at nonprofit community providers that mainly provide family planning or reproductive services. These are some of the most critical health care needs young adults have. Young women could be disproportionately affected, given that they frequently seek primary preventive services, such as well-woman care, from these providers.
The bill would also prohibit states from increasing taxes on health care providers and using this revenue to qualify for federal matching payments. These taxes are an important way states fund their portion of Medicaid costs.
If they’re less able to draw on this revenue source, states are likely to cut provider payments. This would likely reduce the number of providers that accept Medicaid and the amount of services they provide. That would make it harder for all enrollees, including young adults, to access care.
Removing incentives for more states to expand Medicaid would eliminate a key opportunity to increase insurance coverage for young adults. Young adults have the highest uninsurance rate of any age group (about 11 percent) and the lowest rates of employer-provided health insurance.
The House bill would eliminate enhanced federal funding for states that choose to expand Medicaid for the first time. This would deter additional states from expanding coverage to adults with low incomes, leaving on the table a key avenue to increase health insurance coverage for young adults.
Taken together, evidence suggests that proposed changes to Medicaid would create new hurdles for young adults as they are working to achieve self-sufficiency.
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