After weeks of closed-door discussions and secretive planning sessions, Senate Republicans on Thursday released the text of their long-awaited healthcare bill, which they plan to vote on next week. The Senate’s “Better Care Reconciliation Act” (BCRA) was supposed to be a more moderate version of the House of Representative’s American Health Care Act (AHCA), but the proposal we saw this week is anything but moderate.

Like the House version, the Senate bill proposes drastic cuts to spending on healthcare for low- and middle-income Americans in order to fund a tax break for those who earn more than $200,000 a year – which is immediately problematic. Among other fundamental changes to the healthcare system, the bill undermines consumer protections and proposes draconian cuts to Medicaid, the government-run health insurance plan that provides coverage to pregnant women, single mothers, individuals with disabilities, and low-income seniors. While the Senate version has not yet been scored by the Congressional Budget Office (CBO), the CBO’s analysis of the AHCA estimates that of the 23 million people who will lose insurance coverage, about 60% –or 14 million people—will lose it because of AHCA’s massive cuts to Medicaid.

While everyone stands to be affected by these changes, young adults may be surprised to learn how much they have to lose.

Young adults have traditionally had the highest uninsured rate of any age group in the country, in part because young people have limited access to employer-based insurance plans. Compared to middle-aged and older adults, young people are more likely to work in entry-level or part-time jobs, most of which do not offer health insurance to employees. Before the Affordable Care Act, about 30% of men and women aged 19–25 lacked health insurance — nearly double the national average of 16% among Americans of all ages. This all changed with the September 2010 enactment of the ACA’s dependent care coverage provision, which allows young adults to remain on their parents’ health insurance plans until their 26th birthday. Five years after this provision went into effect, the uninsured rate among young adults had been cut in half, falling to an estimated 14.5%. Thanks to these coverage gains, more young people are accessing preventive services like cancer screenings and vaccines, and treatment rates for young adults with mental health disorders have increased significantly. As a result, young adults are spending less on out-of-pocket health care costs and reporting improvements in health status. One recent study even found that the coverage gains resulting from the ACA’s dependent coverage provision are associated with a significant reduction in mortality rates among young people aged 19-25.

While everyone stands to be affected by these changes, young adults may be surprised to learn how much they have to lose.

The Republican replacement plan imperils many of these gains. While it doesn’t eliminate the dependent coverage provision, the AHCA still jeopardizes coverage for young adults by eliminating the individual mandate to purchase insurance and placing restrictions on financial assistance to families. According to a recent study, the individual mandate enhances the effects of the dependent care provision, and removing it would result in some loss of insurance coverage among those aged 19-25. Additionally, reducing the amount of financial assistance available to purchase insurance, as the new plan proposes to do, may make it too costly to keep young adults on the family’s health insurance plan. The study also reported that the Republican replacement plan’s penalty on those who let their coverage lapse is expected to hit young adults the hardest. Under the GOP plan, individuals can be charged 30% higher premiums for a year if they have a lapse in coverage — a scenario that is common for students entering college and young adults getting entry-level jobs.

Essential benefits and pre-existing conditions The Republican healthcare plan also permits states to opt-out of providing the ACA’s mandatory essential health benefits, which would allow insurers in those states to decide whether to provide coverage for basic services, including birth control and other prescription drugs, disease screenings and preventive health care services, mental health and substance abuse treatment and pregnancy-related services. While this provision will affect the cost and availability of basic healthcare services for all Americans, the implications are especially dire for the millions of individuals with preexisting conditions, which includes nearly 20% of young people aged 18-24 and 25% of those aged 25-34. As the Center for American Progress reported, allowing states to waive coverage of essential health benefits “would enable insurers to effectively screen out sick people by excluding certain services.” As a result, individuals with preexisting conditions “would face significantly higher costs and find it much harder to find insurance plans that actually covered treatment for even relatively common conditions such as mental health problems or diabetes.” In other words, while insurers cannot deny coverage based on a person’s health status, they can decide to offer plans that don’t include any of the essential services that a person with a preexisting condition actually needs, and to charge exorbitant prices for plans that do include such coverage.

While insurers cannot deny coverage based on a person’s health status, they can decide to offer plans that don’t include any of the essential services that a person with a preexisting condition actually needs.

Substance abuse treatment Another issue of particular importance to young adults is the impact of Medicaid cuts on the availability of substance abuse treatment. According to addiction medicine specialists, reducing eligibility for Medicaid and scaling back the ACA’s Medicaid expansion could have deadly consequences as the country struggles to deal with a growing opioid addiction crisis that is affecting young people more than any other group. Over the past decade, heroin use has more than doubled among young people aged 18–25, and the rate of fatal prescription drug overdoses in this age group has quadrupled since 1999. As the largest payer in the country for addiction and mental health treatment, Medicaid currently pays for about 1.2 million individuals to receive treatment for opioid addiction. Rolling back the recent expansion of Medicaid would rescind about $4.5 billion in annual funding for addiction treatment, resulting in dramatic reductions in the availability of treatment services for those who need it. At a recent meeting of the President’s Commission on Combatting Drug Abuse and the Opioid crisis, addiction experts called on lawmakers to protect Medicaid funding or risk worsening the opioid crisis.

“Since the majority of increased opiate deaths and suicide occur in young and middle-aged adults, which is the expansion population, the Medicaid expansions must be maintained and completed,” said Joe Parks, M.D., medical director for the National Council for Behavioral Health.

Women’s health care The healthcare bill, which was designed by a group of 13 Republican men, includes several provisions that are particularly harmful for women’s health. The bill proposes to eliminate Medicaid reimbursements for Planned Parenthood, which could significantly reduce young women’s access to reproductive, sexual, and preventive health care services. One in five women of reproductive age currently relies on Medicaid for health care services such as birth control, family planning, STD tests and treatment, well-woman visits, and maternity care and about half of the 2.5 million patients who visit Planned Parenthood centers every year receive sexual health services through Medicaid. Furthermore, the current version of the bill would allow states to impose work requirements as a condition of Medicaid coverage, including among new mothers. This means that women who do not find work within 60 days of childbirth could have their Medicaid coverage revoked entirely. On top of these provisions, the bill also prohibits individuals from receiving federal subsidies to pay for health insurance if they choose a plan that covers abortion (regardless of whether they actually have an abortion), with exceptions made only in cases of rape, incest, or when the life of the mother is in danger. As a result, insurance companies will likely stop providing abortion coverage on their basic plans. If women want to purchase a plan with abortion coverage, they will likely have to pay more for the plan and will not be allowed to use subsidies to make it more affordable.

While young people are generally healthier and require less medical care than older adults, lacking insurance coverage has significant health and financial implications even for young Americans. Before the ACA, about 60% of young adults reported skipping out on necessary health care in the past year because of costs, and more than half reported problems paying medical bills or said they were paying off medical debt over time. If Republicans are successful in their efforts to repeal the current healthcare law, young adults may find themselves even worse off than they were in the days before the ACA. Meanwhile, the wealthiest families in our nation will benefit from a tax break – but it will come at the expense of millions of everyday Americans.