I never expected to go on Medicaid. I grew up in a comfortable household, had worked since high school, and was a generally healthy 24-year-old public policy graduate student.
I also never expected the stubborn lump above my collarbone would be Hodgkin’s lymphoma.
At first, I wasn’t too worried — about money, at least. Under the Affordable Care Act, I was still on my parents’ private insurance plan. But it soon became clear that our plan wouldn’t cover the full cost of my treatments, which came with thousands of dollars in coinsurance payments before hitting our deductible.
I would also need to drop to a part-time course load — treatment left me totally exhausted — which meant paying for another semester of rent and tuition to complete my degree.
Further, because cancer threatened my fertility, I spent thousands on egg preservation, which was outside the scope of my insurance. I was fortunate that my family and friends could help, but I would undoubtedly bear some burden — and was already $100,000 in student debt.
As I imagined medical debt piling atop my existing loans, I saw my future goals to become a public servant, travel, buy a house, marry, and have kids crumbling away.
Still, when a gentle hospital social worker urged me to apply for Medicaid, my first reaction was shame. I was eligible — as a student, I had no income — and I urgently needed the help.
That is how, when I least expected it, Medicaid became my lifeline. As my secondary insurance, it covered me when my private plan didn’t, and later it became my only plan when I aged out of my parents’ insurance and entered cancer survivorship.
Now, H.R. 1 — the “big, beautiful” mega-bill that passed the Senate on Tuesday — puts Medicaid on the chopping block. If passed, it would make life harder for young people trying to navigate adulthood while facing their own health struggles.
The legislation would cut Medicaid spending by hundreds of billions of dollars while imposing work and reporting requirements that could threaten coverage for 10.9 million people or more by 2034. About one in three young adults (ages 18 to 24) are on Medicaid, including about 3.5 million college students.
For many young people, Medicaid might be their best or only insurance option. Gen Zers often work irregularly, part time, or in the gig economy, and many workers start their careers in low-wage or temporary jobs without employer-sponsored health insurance. Partly for these reasons, this age group has the highest uninsurance rate in the United States.
As written, the bill would require people on Medicaid to work at least 80 hours a month, perform certain volunteer work, or report an exemption, such as severe illness or disability, to retain coverage. The bill would also require enrollees to verify their income and residency twice as often.
These “work requirements” and new eligibility checks save the government money by shedding qualified recipients who get lost in its unwieldy paperwork requirements.
When Arkansas instituted Medicaid work requirements in 2018, 18,000 people quickly lost their coverage, including those who were working or otherwise exempt. Later research found the policy did not produce a bump in employment.
The proposed changes in H.R. 1 also pose particular challenges to young people, who are more likely to encounter hurdles to reporting — such as finding the right documentation, jumping between jobs and houses or apartments, and navigating new and unfamiliar bureaucracies.
And of course, everything is harder for young people facing serious illness. Though I wanted to work during treatment, intense chemotherapy made even taking a short walk feel impossible. I was bleeding money, not just for treatment but for hospital transportation and over-the-counter medications. Any coverage loss because of a missed reporting deadline or inability to work would have been financially catastrophic.
