Will Trump’s Bill Reverse Health Improvements for College Students?

In the 11 years since the implementation of the Affordable Care Act, state-level Medicaid expansions have had a positive impact on college students, studies show. Uninsured rates dropped, graduation rates improved and more students were able to access mental health diagnoses and medication.

Now experts fear those improvements could be at risk due to the Medicaid cuts and paperwork requirements included in President Donald Trump’s One Big Beautiful Bill Act. 

“We can see direct effects in terms of students’ ability to succeed in college when they have health insurance, many of them … through Medicaid,” said Peter Granville, a fellow at the Century Foundation, a progressive think tank. “By extension, we can expect cuts to Medicaid to have negative impacts on students’ abilities to succeed in college and get their degree.”

The changes to Medicaid come on top of other financial blows to students included in the legislation, including new caps on federal student loans. They also arrive at a time when more young people are citing mental health challenges as a main reason they’re not planning to attend college. And young people’s mental health continues to suffer, with one in 10 of those between 12 and 17 reporting thoughts of suicide, according to a new Substance Abuse and Mental Health Services Administration report, making access to affordable mental health care all the more vital.

“Those are the exact people who are going to be hitting college age” when certain Medicaid-related provisions, like new work requirements, go into effect, said Hannah Wesolowski, chief advocacy officer at the National Alliance on Mental Illness. “There’s already a lot of mental health burden on that age group.”

Students on Medicaid

The ACA made it possible for states to expand Medicaid coverage to people living at 138 percent of the poverty line; as of 2025, 40 states and Washington, D.C., have done just that. Along with raising the income cap for Medicaid, states also expanded eligibility to childless adults, a demographic that includes many college students. But with the passage of $990 billion in cuts to Medicaid over 10 years, experts worry college students may be among those at risk of losing coverage. If that happens, they warn, low-income students might be unable to balance the cost of tuition with the cost of private insurance.

“Under the proposed cuts, many college students may lose access to health coverage, including mental health care, which is vital to academic success,” wrote Ted Mitchell, the president of the American Council on Education, in a letter to the House Committee on Energy and Commerce, which passed the Medicaid provisions in the bill. “Students relying on individual market coverage could see increased out-of-pocket costs, forcing them to choose between healthcare and paying for tuition, books, or other essential needs. This financial strain could lead to higher dropout rates and worsened health outcomes, undermining both student academic success and workforce development.”

If students end up uninsured as a result of the cuts, said Granville, it’s likely that even a minor medical emergency would cost so much it could derail their education or send them into credit card debt.

“They may say, ‘OK, this molar I had to just get extracted, I’m just going to put that on my credit card and I’m going to hope that something works out,’” he said. “That is then very risky when you consider that credit card debt has interest rates in the high 20s, often.”

Academic Impacts

Losing access to Medicaid may also force more students to work while they’re in college, which could negatively affect their academics. Economists Priyanka Anand and Dora Gicheva, professors at George Mason University and the University of North Carolina at Greensboro, respectively, found that students in Medicaid expansion states were less likely to work full-time, according to a study they published in 2024. They suggest that access to Medicaid meant students didn’t feel pressure to obtain health insurance through an employer anymore, freeing them up to focus on their studies. Students in Medicaid expansion states were also 11 percent more likely to graduate; for community college students, that share climbed to 22 percent.

“We interpreted that [as meaning that] by providing college students with Medicaid … they’re able to shift their focus from work to school,” Anand said.

One study on student mental health post–Medicaid expansion shows that college students in expansion states were more likely to take certain steps to improve their mental health, such as obtaining mental health diagnoses and medication. (However, it didn’t find a difference in grade point averages based on whether students lived in a Medicaid expansion state or not.)

Along with concerns about Medicaid cuts overall, experts raised alarm about the OBBBA’s new work requirements for Medicaid recipients, who must work 80 hours per month (although students going to school at least half-time also qualify). Still, a significant portion of students—about 20 percent of Pell Grant recipients, according to a recent analysis by the Center for American Progress—attend college less than half-time and would have to supplement their schedule with work to qualify for Medicaid. (Earlier versions of the OBBBA proposed eliminating Pell eligibility for those students, but that was removed from the final version of the legislation.)

Wesolowski, of NAMI, said that just reporting the new work requirement may be an impediment to college students.

“The state does not have access to all student information and may not know someone is a student,” she said. “The fear is some people might be struggling on Medicaid while they’re in college, trying to put themselves through school on loans and may not know about this requirement or may not report their school time in the right way and lose coverage, even though they’re technically meeting the requirement. It’s a paperwork nightmare.”

Granville suggested that one way colleges could help would be to establish emergency funds that students can pull from if a medical emergency arises. That way, uninsured students can pay for the unexpected costs without taking out loans or incurring credit card debt.

“It can be a really good use of 500 or 1,000 dollars to keep a student enrolled,” he said. “That’s especially true when the expense is related to their health—if it’s something they truly could not go without.”