When Tuition Meets a Medical Bill: How the OBBBA Threatens Student Health

The 2025 One Big Beautiful Bill Act (OBBBA), signed into law, reshapes numerous pieces of legislation, particularly those related to healthcare, education, and the allocation of public funding. While the media has covered the changes to Medicare and Medicaid eligibility as well as the restructuring of loan payments, the implications on college students caught between the intersections of these policy changes are often not discussed. 

The expansion of Medicaid eligibility has already reshaped students' access to healthcare. As of 2022, nearly 13% of college students were enrolled in Medicaid, an increase from the 8% enrolled preceding the Affordable Care Act. These statistics indicate that many students actively rely on Medicaid for checkups, prescriptions, and mental health visits. Yet, the OBBBA introduces work requirements for Medicaid coverage, threatening to complicate previous strides towards accessibility. For students already balancing classes and extracurriculars, these requirements risk turning health coverage into an additional barrier to their education and health. In practice, work requirements penalize students for prioritizing their education, creating a “coverage cliff” for those who cannot meet the demands of both school and work, resulting in a situation where a person loses access to health benefits. Without careful exemptions tailored to student realities, the expansion of coverage under OBBBA may be undermined by the very conditions it is intended to address. 

Access to Medicaid has been crucial for improving student health outcomes. For example, the mental health crisis is severely affecting college students. For many students, Medicaid has provided consistent access to mental health services that would otherwise be cost-prohibitive. OBBBA restrictions will force students to delay care until their conditions escalate into academic disruption or emergency room visits. 

At the same time, OBBBA’s new federal loan caps narrow another important avenue for students to meet their health needs. According to Federal Student Aid guidelines, loan disbursements can be used for living expenses after tuition and fees are paid, including health-related costs. For students managing chronic conditions, unexpected injuries, or prescriptions, these loan refunds provide a financial buffer. While such reliance is not ideal, it reflects a reality in which students’ education and healthcare costs are deeply intertwined. Although the OBBBA’s proposed tighter caps are intended to reduce national debt burdens, they may inadvertently limit students’ financial flexibility at precisely the moments they need it most.

Students who exceed federal loan caps are often pushed toward riskier private credit, which lacks borrower protections and worsens long-term financial instability. The convergence of stricter Medicaid eligibility and reduced loan flexibility may result in fewer students qualifying for Medicaid, while also having a diminished ability to absorb health costs through educational loans.

A medical bill is not separate from a tuition bill when both land on the desk of a 20-year-old with limited savings. By addressing one sphere of student finance without accounting for healthcare, OBBBA risks exacerbating the very financial struggles it claims to alleviate. It is tempting to view student health policy as a niche issue. After all, students are often seen as young, resilient, and with transient concerns. However, this view misses the long-term consequences. Students who live with childhood-onset chronic conditions have a reduced likelihood of graduation and limited participation in the workforce. If we consider how these conditions persist into college, where students must often navigate healthcare coverage on their own, the consequences become even more pronounced. These coverage gaps not only affect individual health but also have long-term economic consequences. Therefore, delays in care for depression, asthma, or diabetes today translate into higher healthcare costs and reduced productivity tomorrow. In this way, the provisions of OBBBA are about human capital.

With the OBBBA now signed into law, the question is not whether it will affect students, but how those effects will be managed. Universities, policymakers, and advocacy organizations have an opportunity and an obligation to ensure the bill’s implementation does not deepen inequality. Several steps are crucial, such as protecting Medicaid access by carving out exemptions for full-time students from rigid work requirements. Additionally, it is crucial to expand campus health infrastructure to address gaps in insurance coverage, particularly in mental health services. Finally, integrating healthcare and education finance by creating emergency grants or forgiveness programs will help absorb medical shocks.

The “One Big Beautiful Bill Act” is on track to become a turning point in US healthcare. However, its true measure on the country will not be found in budget projections or partisan talking points. It will be felt by students, especially those balancing chronic illness with class schedules and therapy bills with tuition payments, trying to stay healthy enough to succeed. Healthcare policy is student policy. In diminishing student access to equitable resources, OBBBA potentially threatens the health and outcomes of the next generation of graduates and the workforces they aim to enter.

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Mahyub Hamida, Pexels License, via Pexels