The Republican-led Congress is considering plans to cut Medicaid to help pay for tax cuts, with the House budget resolution targeting $880 billion or more in potential reductions to federal Medicaid spending. Medicaid is the primary program providing comprehensive health and long-term care to one in five people living in the U.S and accounts for nearly $1 out of every $5 spent on health care. Reductions in Medicaid could have implications for enrollees as well as plans, providers, and state budgets. While there are several policy options under consideration in Congress to achieve savings, it is not clear how much support there is from Republicans (including President Trump) about these specific policies. The discussions in Congress come at a time when support for the Medicaid program continues to be strong. According to KFF polling, Medicaid is viewed favorably by a large majority (77%) of the public and an even larger share of those on the program (84%). As Congress considers reducing Medicaid spending, nearly half (46%) of all people and nearly two-thirds (62%) of Medicaid enrollees believe the federal government is currently not spending enough on the program.

To better understand the experiences of Medicaid enrollees and their perceptions of potential changes to the program, KFF conducted five virtual focus groups in January, including three groups with participants who had voted for President Trump in the 2024 election and two groups with participants who had voted for Vice President Harris. Focus group participants were asked about their experiences with their Medicaid coverage, views on government’s role in health care, and perceptions of the recent election. Participants were also asked for their reaction to current proposals to reduce federal spending on Medicaid and impose work requirements. Despite differences in who they voted for in November 2024, participants had consistently favorable experiences with Medicaid and concerns with potential cuts to the program. Key findings from our groups include the following:

Many Trump and Harris voters said that their top voting issue in the 2024 election was the economy, though some Trump voters cited immigration, and some Harris voters cited women’s rights as their top issues, and most participants said they did not recall hearing about changes to health care programs (including Medicaid) during the campaign. Most participants said the government has a role to play in making health care more affordable and accessible, but some Trump voters argued the private sector does a better job of controlling costs. When asked about fraud in the Medicaid program, many participants said they thought fraud exists, but views differed on whether it is a major issue and what was the primary cause. Several Trump voters believed the problem was due to people enrolled who were not eligible; however, other participants, including both Trump and Harris voters countered that state verification procedures prevent individuals from defrauding the program on a large scale and that providers and insurance companies were more likely the main source of program fraud.

At the time of the focus groups, most participants had not heard about proposals to reduce federal spending on Medicaid, and while most did not know why the reductions were proposed, some Trump voters suggested they were part of the crackdown on illegal immigration and aimed at removing undocumented immigrants from the program (undocumented immigrants are not eligible for federally-funded Medicaid). Participants opposed cutting Medicaid funding to pay for tax cuts that they did not believe would benefit them. Both Trump and Harris voters expressed fears that these changes would jeopardize the program, take away access to health care, result in worse health outcomes, and increase out-of-pocket costs. A few Trump voters did not believe Trump would follow through on the cuts to Medicaid because they believed he understood their financial struggles.

Both Trump and Harris voters valued their Medicaid coverage and the access to health care services, mental health services, and medications for themselves and their children it provides. Participants also valued Medicaid because it helps to protect them from financial disaster, alleviates stress, improves health outcomes and often supports their ability to work. Participants said losing Medicaid would “be devastating” and lead to serious consequences for their physical and mental health and exacerbate pre-existing financial challenges.

If work requirements were introduced to Medicaid, participants who were working generally felt confident in their ability to meet the requirements; however, they worried about the burden of monthly reporting requirements when those were described to them. Many participants across parties noted that access to treatment for chronic conditions, including prescription medications and mental health treatment, were key in helping to support their ability to work. More Trump voters supported a work requirement but some who were not working were convinced they would qualify for an exemption. Other participants, including both Trump and Harris voters, who were not currently working felt they would face challenges in meeting the requirements. Those who were not working said they wanted to work (and many had been previously working for many years) but were generally unable to because of disability or because they were caring for young children or a sick parent.

Both Trump and Harris voters wanted policymakers to focus on improving Medicaid instead of cutting it. For example, some participants said they would like to see enhanced dental benefits, increased doctor availability, and fewer prior authorization requests. Focus group participants wanted policymakers to consider the implications of federal cuts to Medicaid for people, their health, financial stability, and ability to be productive members of society.

General Situation

Most focus group participants were experiencing financial challenges and were managing an array of physical and/or mental health conditions. Medicaid eligibility requirements mean those on the program, by definition, have low incomes. Most participants described struggling with high food prices and noted the past few years have been financially difficult. Some focus group participants reported difficulties with the current job market or described injuries or disabilities that made it difficult to find employment. Focus group participants were managing an array of health conditions including high blood pressure, diabetes, physical disabilities, chronic pain, asthma, and anxiety and depression. Some were managing more complex and potentially disabling conditions, such as cystic fibrosis and hidradenitis suppurativa (HS). Along with managing their own conditions, some participants were also caring for parents or other family members in nursing care.

“Times are tough right now. You know, everything’s overpriced and no one’s working and can’t afford anything and my health is terrible, so it’s kind of tough times.” 50-year-old, White female

(Trump voter, Nevada)

Experiences with Medicaid

Participants valued their Medicaid coverage and the access to health care services, mental health services, and medications for themselves and their children it provides. Along with regular physical exams for themselves and their children, focus group participants reported using Medicaid to see specialists, access mental health and substance use disorder treatment, receive necessary surgeries, and get prescription medications. Some participants with health conditions requiring frequent visits with specialists or multiple daily medications said they could not imagine day-to-day life without Medicaid.

“Doctor’s visits, I take 30 pills a day, so it covers all that, which is nice. I see the ENT like every other week.” 35-year-old, White female

(Trump voter, North Carolina) “I’m really grateful for it. When I first got on it, it covered for 90 days for me to go to a rehab and then it has covered my prescriptions with no questions asked.” 33-year-old, White female

(Trump voter, Arizona)

Participants described Medicaid coverage as affordable, noting that it protects them from financial disaster and alleviates stress. Participants expressed gratitude that they could access necessary medications with little to no cost sharing, and in general were appreciative that they had no premiums and low out-of-pocket costs. Participants said that having Medicaid reduces stress related to unexpected medical costs. Prior to enrolling in Medicaid, many participants had been uninsured and had gone long periods of time without seeing a doctor. These participants were grateful that they were now able to access regular care. Those who had previously looked into or been enrolled in private insurance described Medicaid as a more affordable source of coverage.

“I never took insurance from where I was employed at because it was always so expensive. By the time they would take out the money, there wasn’t much of a check. So I was basically gonna be paying for insurance, which I know a lot of people have to do. Went a while without anything so Medicaid’s been really great as far as helping me out with doctor appointments, used to help me out with dental. I used it a little bit for mental therapy when I lost my daughter unexpectedly. So it’s been good.” 61-year-old, White female

(Trump voter, Kentucky)

While participants said Medicaid was generally working well for them, some would like to see improvements, including enhanced dental benefits, increased doctor availability, and fewer prior authorization requests. Participants noted that it can be difficult to find doctors accepting Medicaid and frustrating to navigate prior authorizations for needed care. Other complaints included high turnover rates among providers at clinics that accept Medicaid and certain prescriptions not being covered by the program. Many focus group participants also wished that their state either covered dental benefits or had more generous dental benefits.

“There’s not like every doctor available, thankfully the doc I had before, I still am on the same doctor ’cause he is under my Medicaid, which is good. But there’s not coverage everywhere and certain things, so that’s kind of, you know, slight disadvantage there.” 59-year-old, White male

(Harris voter, Pennsylvania)

Views on Government’s Role in Health Care

Participants felt that being able to easily access affordable health care services is essential to ensuring they can work and lead productive lives. Across voting parties, most participants felt that everyone deserved access to affordable health coverage, with many saying that people should not have to pay for what they described as “life or death” care. Some participants noted that being able to access health care services helps them to work, be more productive, and contribute to society. However, a few Trump voters talked about the need for people to take responsibility for their health suggesting that they did not believe health care was a right for everyone.

“Healthcare is a right because you want the American people to work. So in order for the American people to work, they need to be healthy to work.” 52-year-old, Black female

(Trump voter, Pennsylvania) “If we’re healthier, it makes our country healthier and we produce. If you got a bunch of sick people that have no insurance, all you’re gonna do is cause debt, death, and god knows what else.” 56-year-old, White male

(Harris voter, Ohio)

Most participants said the government has a role to play in making health care more affordable and accessible; however, some Trump voters opposed government playing too large a role in running the health care system. Both Trump and Harris voters said the government has a role in making coverage more affordable, but some Trump voters noted that they felt private businesses may be more effective at keeping health care costs affordable than the federal government. More Harris voters (and some Trump voters) felt that the government should play a role in helping everyone access health care and in making the system work better. Both Trump and Harris voters compared the U.S. to other countries with nationalized health care systems, though takeaways from these comparisons differed. Some Trump voters referenced long wait times for care in other countries as evidence for why they did not think the U.S. should move to a socialized medicine model. Others (including both Trump and Harris voters) noted that the government should offer free care for all citizens, similar to other countries.

“It should be available for everybody. And it should be affordable. Because not everybody can afford the same thing… it’s usually the private sector does a better job with lowering costs and making things affordable and having options for people, not the government. I pay enough already in taxes that I don’t need to control anymore what I have to pay taxes for.” 45-year-old, Black male

(Trump voter, Kentucky) “It shouldn’t be an issue in a country this rich that people are going without it. I mean, it shouldn’t even be a question. It should be cut and dry. And we look at other countries, you know, it’s something they already have that the citizens have. And for a country that’s rich as America, it shouldn’t be your money or your life. You shouldn’t have to choose between medicine or buying food, or medicine and paying your life bill. It’s a right of an American citizen.” 61-year-old, Black female

(Harris voter, Kentucky)

Election Experiences

Many Trump and Harris voters said that their top voting issue in the 2024 election was the economy. Most Trump and Harris voters cast their ballot based on economic concerns and which candidate they thought would address their pocketbook issues, including housing costs and grocery prices. Some Trump voters noted that their standard of living was better under the first Trump administration while some Harris voters were worried that Trump would cut benefits. Immigration was a top voting issue for some Trump voters, especially for those living in border states. A few Harris voters cited women’s issues and preserving democracy as the motivations for their votes.

“When Trump was in office from ‘16 to ‘20, you know, my standard of living was better than it is now.” 43-year-old, White male

(Trump voter, Pennsylvania) “Someone who’s not about to cut food stamps, cut housing, cut WIC, cut many stuff that we everyday people need.” 45-year-old, Black female

(Harris voter, Ohio)

Most participants said they did not recall hearing either candidate mention changes to health care programs (including Medicaid) during the campaign. Because other issues, including immigration and the economy, dominated the campaign, most participants were unaware of either candidate’s health care priorities and any policy changes they planned to make. Some Harris voters recalled Harris discussing women’s health care and abortion access, and a couple of participants said they heard that Trump would either try to get rid of Obamacare (the Affordable Care Act) or would fix it. However, for the most part, health care issues were not a dominant factor in the election for these voters.

“I didn’t hear a peep about healthcare. Nope. It’s immigration for me.” 56-year-old, White male

(Trump voter, Arizona) “I think Kamala talked about healthcare like for women’s rights a lot. I feel like that was kind of one of her main points… I had never really heard Donald Trump talk about it. I heard about it in like Project 2025.” 25-year-old Black female

(Harris voter, Pennsylvania)

Proposals to Reduce Federal Medicaid Spending

At the time of the focus groups, most participants had not heard about proposals to reduce federal spending on Medicaid, but Trump and Harris voters had different opinions on why the cuts were being proposed. No Trump voters and only a very few Harris voters said they were aware of proposals in Congress to reduce federal spending on Medicaid, and many were surprised to hear of the proposed cuts. Although most participants were not sure why the spending reductions had been proposed, some Trump voters theorized that it was part of the administration’s crackdown on illegal immigration and an effort to remove undocumented immigrants from the program (undocumented immigrants are not eligible for federally-funded Medicaid). A few Trump voters did not think Trump would follow through on the cuts because they believed he understood their financial struggles. Some Harris voters felt the proposals reflected a pattern by Republican lawmakers to reduce benefits for poor Americans.

“I’m a border state, so we’ve had so many illegals coming through and the previous administration they got all free social services. So I imagine that’s part of the thing that we were giving Medicaid to people who have been here hours and stuff. And so it’s one way to prevent or to get some cost cutting.” 59-year-old, Hispanic female

(Trump voter, Arizona) “Their goal is to make sure that we don’t have anything. So why they’re taking everything outta everything because the rich wanna get richer.” 58-year-old, Black female

(Harris voter, Ohio) “I think Trump knows that people are struggling right now, and I don’t think he’s gonna do, at least not right now, cut anything Medicaid because he just knows people’s financial problems right now.” 45-year-old, Hispanic male

(Trump voter, Arizona)

When asked specifically about fraud and abuse in Medicaid, some participants across both groups believed there is fraud and abuse in the Medicaid program, but opinions were mixed on whether the source of the fraud is people enrolled who should not be or providers and insurance companies taking advantage of the system. The Trump administration has tied current actions to reduce federal spending to eradicating fraud, waste, and abuse within government programs. Many focus group participants agreed there was fraud in the Medicaid program; however, some described fraud as a major problem in the program and others reasoned there is fraud in Medicaid because there is fraud everywhere. When identifying the source of fraud in Medicaid, several Trump voters believed fraud was primarily due to people enrolled who were not eligible. Other participants, including both Trump and Harris voters countered that it would be too difficult for individuals to defraud the program on a large scale, describing how their states verify their income and other information at application and renewal. Some participants believed that providers and insurance companies overcharging the program or billing for services they did not provide were to blame rather than individuals. These participants offered examples of providers in their states who were convicted of fraud.

“Fraud is probably pretty prevalent, just like it was in everything else… People can abuse anything, so. If they have access to that, I’m sure there’s been some fraud over the years with Medicaid.” 56-year-old, White male

(Trump voter, Arizona) “I think it’s organizations more than people. I think it’s kind of hard to defraud with Medicaid. I mean, what are you doing going and asking for prescriptions and then selling them on the side? I mean, I don’t know how you would or having a high paying job and pretending you don’t work. I mean everything is available now on the internet. Everything’s tied in. Like me, our local Medicaid in Arizona was able to access my paychecks even before I saw what I was going to get one time they had it already on their screen.” 59-year-old, Hispanic female

(Trump voter, Arizona) “Most of the fraud that I’ve heard about comes from the actual provider billing for things they didn’t do.” 45-year-old, Black female

(Harris voter, North Carolina)

Both Trump and Harris voters opposed cuts to the program fearing that Medicaid spending reductions would jeopardize the program and take away access to health care for poor people. Likely because of their reliance on the Medicaid program, participants opposed reducing spending on Medicaid, and many used strong language to describe the dire consequences of making major cuts to the program. Some participants predicted people would lose coverage if cuts were made to the program, and one participant suggested the economy would suffer because many of the people currently on the program would no longer be able to get the care they need. Others anticipated that states would cut benefits, particularly for prescription medications and mental health care, and that providers would stop participating in the program.

“We shouldn’t have to suffer because of somebody wanting to propose cuts to it, you know, because we, we didn’t do anything. So, you know, let it, it can come from somewhere else. I just, I would oppose it.” 60-year-old, Black male

(Trump voter, Missouri) “People would be unable to take care of themselves and be healthy and get mental health issues taken care of, to get vision and dental; people would suffer. They wouldn’t be able to work. And the economy would suffer.” 55-year-old, White female

(Trump voter, Oklahoma) “I would oppose [cutting Medicaid] just because there’s a lot of people who need it, who would be affected by it negatively.” 29-year-old, White male

(Trump voter, Pennsylvania)

Participants opposed cutting Medicaid funding to pay for tax cuts that they did not believe would benefit them. Participants explained that because they had low incomes and were already in a low tax bracket, they did not expect their taxes would change much under any tax cut proposal. Both Trump and Harris voters said they would prefer Medicaid coverage to continue unchanged, arguing that the negative consequences of any changes to Medicaid would outweigh any small benefits they would experience from tax cuts. They said other government spending should be targeted to finance tax cuts.

“I don’t make much money to get my taxes affected by that. It would hurt my Medicaid, my medical more.” 50-year-old, White female

(Trump voter, Nevada) “They need to start taxing the right people properly first and then we can discuss that matter. Because we’re the only ones that are paying the taxes… They could put more into the programs if they tax the proper people properly.” 56-year-old, White male

(Harris voter, Ohio)

Participants expected significant changes to the Medicaid program if federal funding were reduced and they worried they would lose coverage or face higher costs. Possible Medicaid spending cuts felt very personal to participants who expected they would be negatively affected by the proposed changes. Participants expressed anxiety over how reduced federal spending may affect out-of-pocket expenses, doctor availability, and covered benefits. Some described life and death consequences of not being able to access mental health care and prescription medications to manage their chronic conditions. Others focused on the financial implications of losing coverage and the impact that would have on their ability to work as well as on out-of-pocket costs for needed care. For participants with family members in nursing homes, the challenge of caring for them at home seemed daunting.

“I would be very worried. It would [mean] not being able to get my antidepressants [and] see a psychiatrist. Yeah, it would, it might crush me.” 45-year-old, Hispanic male

(Trump voter, Arizona) “States are gonna have to start dropping people off the rolls. People like us who are probably single and childless.” 45-year-old, Hispanic male

(Harris voter, Arizona) “It’s gonna be higher out of pocket costs for sure. You know, and that’s something I can’t afford. It’s not just me, it’s me and five other people, you know. So I can’t afford that for me, nonetheless them.” 45-year-old, Black female

(Harris voter, Ohio)

Work Requirements

While some participants were working full-time, many who were working part-time or not working said they wanted to work or work more hours but were unable to because of disability or because they were caring for young children or a sick parent. Participants were working a variety of jobs, including home health aide, dental assistant, tax preparer and gig and contract work, but they needed Medicaid because they were not offered insurance through their work. Several said they were working part-time or not working because of illness or disability or because they were caring for young children or aging parents. Others said that they wanted to be working but have been unable to find employment. For those who were not working for a reason other than disability or illness, several said that to be able to work, they would need supports like affordable childcare, transportation, internet access, or better opportunities in their communities.

“I do self work with Instacart because …I get to pick and choose the days I’m able to work and dealing with my dad, getting in that nursing home and also dealing with my mom now because she’s getting into that phase where she’s needing more doctor appointments.” 52-year-old, Black male

(Trump voter, Missouri) “I can’t work right now because of my back. And I mean, I believe that my back got as bad as it did because I couldn’t go to the doctor when I didn’t have insurance.” 41-year-old, White female

(Trump voter, North Carolina) “Ever since I haven’t been working, I haven’t been able to find a job that’s legal or decent enough for working from home…They all want somebody in the office to stand up or sit down for long periods of time. I can’t even walk to my vehicle without being in pain. Or get into a vehicle and drive that vehicle because of the stress all behind that.” 51-year-old, Black female

(Harris voter, Oklahoma)

Participants who were working said having Medicaid meant they could get the care they needed, especially medications, and provided financial peace of mind that enabled them to work. With high rates of chronic disease among focus group participants, the ability to manage their conditions was described as critical to their ability to work. This was especially true for participants who said their work sometimes exacerbated their health conditions, such as asthma or chronic pain. Keeping Medicaid was important to participants who were working, and several participants noted the challenge of managing work hours to maintain eligibility. One participant described how she lost coverage for one month because she worked too many hours. The income volatility that many workers on Medicaid experience can put them at risk of losing coverage and access to needed prescriptions and health care for a month or longer.

“I can say that even doing the part-time work, if I did not have Medicaid or wasn’t able to do pain management, I wouldn’t even be able to do those, those small amount of hours.” 45-year-old, Black female

(Harris voter, North Carolina) “It would be really hard for me to work a full-time, 9-5 job with all my doctor’s appointments as well as I’m immunocompromised. It’s definitely positive that I can do something I like, something I wanna do and not work as much and still be able to get insurance.” 35-year-old, White female

(Trump voter, North Carolina) “I found out with Medicaid that there’s a cap on how much I can earn. I wasn’t aware of that. And so actually in the fall I was kicked off for about a month because I apparently had earned too much.” 59-year-old, Hispanic female

(Trump voter, Arizona)

Some participants who were not currently working expressed concerns about imposing work requirements in Medicaid, saying they would face challenges meeting the requirements, while others who supported the policy were convinced they would qualify for an exemption. While most participants had not heard about proposals to introduce work requirements for Medicaid, many Trump and Harris voters who were not working said they did not think they would be able to meet the requirements because of chronic pain or other disabilities. Although not currently working, several of these participants described the high demands of jobs they previously held, noting they had to leave those positions because of injuries or other health conditions. More Trump voters than Harris voters supported a work requirement policy, but several Trump voters who were not working and supported the idea of work requirements strongly believed they would qualify for an exemption because they have a disability or caregiving responsibilities. However, most participants with a disability were not receiving disability income and, therefore, may not meet disability exemptions, which in past proposals have been based on receiving Supplemental Security Income (SSI).

“I can’t because I have chronic pain and I just can’t. I worked until I couldn’t work no more.” 57-year-old, White female

(Trump voter, Missouri) “There’s nothing out here from miles and miles. I live in between two towns and it’s still nothing, you know, so people don’t always have the resources or availability to do what they ask.” 39-year-old, Black female

(Harris voter, North Carolina) “I mean, if you’re able bodied then, then you should still be working and trying and proving to them that you’re able to, ’cause like I said earlier, I want to work, but because of daycare costs, financially I can’t.” 34-year-old, White female

(Trump voter, Kentucky) “I already know I am exempt because I’ve seen this proposal and I already know I was exempt from it. But no, I wouldn’t be able to meet it if I wasn’t exempt.” 57-year-old, White male

(Harris voter, Pennsylvania)

Participants who were working generally felt confident in their ability to meet the requirements; however, some worried about the burden of monthly reporting requirements. Given the number of hours they were working, most participants who were working felt that they would be able to meet any new requirements. But on the issue of reporting on work status monthly, participant opinions diverged. Some said that they were already submitting this information regularly to programs such as SNAP, so they were not worried about this requirement also being required in Medicaid. Others, however, expressed concern about having to report to the state each month, noting that they are human and prone to forget and that reporting requirements can be onerous. They also worried about the consequences of losing coverage for a month if they forget to report their work information in a month. As an alternative to submitting additional paperwork, some suggested an automated system, similar to how income is verified at renewal, would be more efficient.

“Required? Oh yeah. Easy. Oh yeah, absolutely. Mind you, I can’t do certain jobs. I can’t drive, if you will, but yeah, I can, I could do it. I can make it work.” 45-year-old, Hispanic male

(Harris voter, Arizona) “It’s gonna be devastating and upsetting to, you know, if you lose your health insurance if I forget as we tend to, we are only humans, sometimes we forget things. So if I don’t do this [report work hours], it affects the rest of my household and I don’t like that.” 45-year-old, Black female

(Harris voter, Ohio) “I would be very worried about them making mistakes. There’s been many times I’ve sent in paperwork and they didn’t get it and coverage was stopped. You know, a lot of room for clerical error and things like that.” 50-year-old, White female

(Trump voter, Nevada)

Consequences of Losing Medicaid Coverage

Both Trump and Harris voters said that losing Medicaid coverage would be “devastating” and would lead to serious consequences for their physical and mental health. Participants emphasized that the health care services and prescriptions they and their children receive through Medicaid helps them “survive.” Across groups, participants said that losing their Medicaid coverage would create financial challenges and expressed anxiety at the thought of being unable to afford prescriptions, doctor visits, or higher premiums on top of pre-existing financial challenges if there were major changes to Medicaid. Although focus group participants were not aware of the nuances of congressional proposals, all participants were residing in Medicaid expansion states and those who were eligible due to Medicaid expansion could be especially vulnerable to proposed changes in the program.

“I think obviously, not having access to healthcare, or having to have the financial ability to pay for your medical needs, your basic medical needs, is something that we shouldn’t have to worry about because we worry about how we’re going to eat. We worry about how we’re gonna pay our bills… Not having Medicaid would be, not distressful, it would be detrimental because I need to see a primary care doctor, I need to see my specialist.” 58-year-old, Black female

(Harris voter, Ohio) “For me it would, it would probably lead to death, and that’s kinda harshly speaking, but it’s the way that it would be. I’ve relied upon Medicaid for myself in order to survive. For my son, it would be survivable, but it would be difficult. He has real bad allergies, he wouldn’t be able to hear.” 55-year-old, White female

(Trump voter, Oklahoma)

When asked to respond to proposals to reduce federal Medicaid spending, participants appealed to policymakers to consider how these changes would negatively impact people. Participants felt that reducing federal funding for Medicaid would have serious consequences and hurt many people on the program. Some participants pointed out that many people enrolled in Medicaid could not afford any other alternatives and would have no way to access care if they were to lose coverage. The message of several Trump voters to policymakers was to focus on improving Medicaid instead of cutting it. Across groups, participants asked policymakers to remember the human impact of potential changes to the program.

If you or someone you love has borderline personality disorder (BPD) you know this mental health condition can make relationships difficult. People with BPD experience unstable moods, emotional dysregulation, fear of abandonment, impulsive behaviors, and more. Symptoms of BPD also may include risk-taking behavior as well as self-harm or suicidal behaviors. As a result, they commonly experience relationships that are chaotic, intense, and conflict-laden. This can be especially true for romantic relationships.

If you are considering starting a relationship with someone who has BPD (or are in one now), it’s important to educate yourself about the disorder and what to expect. Likewise, if you have been diagnosed with BPD, it can be helpful to think about how your symptoms have affected your dating life and romantic relationships.

What BPD Looks Like in a Relationship

Everyone faces relationship problems at some point. For people with BPD, these problems are so prevalent that they are considered a core symptom of the condition.

In the DSM-5, symptoms of BPD include intense, unstable, and conflicted personal relationships. Research has confirmed that people with BPD tend to have very stormy romantic relationships characterized by a great deal of turmoil and dysfunction.

For example, one study demonstrated that women with BPD symptoms reported greater chronic relationship stress and more frequent conflicts. Also, the more severe a person’s BPD symptoms are the less relationship satisfaction their partner reports.

All of this conflict and turmoil means that people with borderline personality disorder have trouble maintaining relationships. Research has also shown that BPD symptoms are associated with a greater number of romantic relationships over time.

BPD can affect relationships in a variety of ways. Some problems that can come up throughout a relationship with a person with BPD include:

Instability

People with BPD are often terrified that others will leave them. However, they can also shift suddenly to feeling smothered and fearful of intimacy, which leads them to withdraw from relationships. The result is a constant back-and-forth between demands for love or attention and sudden withdrawal or isolation.

Fear of Abandonment

Another BPD symptom that particularly impacts relationships is a deep fear of abandonment. They are always on high alert, looking for any possible sign that someone will leave them. This means that they often misinterpret even minor events as signs of imminent abandonment.

These emotions may result in frantic efforts to avoid abandonment, such as pleading, public scenes, and even physically preventing the other person from leaving.

Lying

Another common complaint of people in relationships with someone with BPD is lying. People with this condition often lie in order to try to avoid being abandoned. Intense emotions, impulsivity, shame, and distorted perceptions also play a role in this tendency to lie.

While lying and deception are not behaviors included in the formal diagnostic criteria for BPD, many loved ones report that lying is one of their biggest concerns. The constant deception undermines trust in relationships.

Impulsive Sexuality

Impulsive sexuality is another classic symptom of BPD, and many people with BPD struggle with issues of sexuality. Also, a large percentage of people with BPD experienced childhood sexual abuse, which can make sex very complicated.

One review published in the Innovations in Clinical Neuroscience looked at how people with BPD differed from those without when it came to sexual behavior. The authors conclude that those with BPD seemed to exhibit impulsivity through various behaviors, including earlier sexual encounters, more casual sexual experiences, and more partners, for example.

Finally, research has also shown BPD symptoms are associated with a higher incidence of unplanned pregnancies in women.

Symptoms with an Indirect Effect

Other symptoms of BPD, including impulsivity, self-harm, and dissociative symptoms, can have an indirect impact on relationships. For example, if a loved one with BPD is engaging in impulsive behaviors like going on spending sprees, it can cause major stress within the family.

Suicidal gestures and ideation can be scary for romantic partners and can introduce lots of stress into the relationship.

Starting a Romantic Relationship When Someone Has BPD

Despite the intense and disruptive symptoms people with BPD and their loved ones must cope with, people with BPD often have many positive qualities that can make them great romantic partners some of the time. Furthermore, many people who have been in a romantic relationship with someone with BPD describe their partner as fun, exciting, and passionate.

Many people are initially drawn to people with BPD precisely because they have intense emotions and a strong desire for intimacy.

Will the Relationship Last?

Most relationships go through a honeymoon period at the start. Relationships with people who have BPD are no exception. In fact, the experience may be magnified.

People with BPD often report that at the beginning of a new romantic relationship, they put their new partner “on a pedestal.” They may feel as though they have found their perfect match—a soulmate who will rescue them from their emotional pain. This kind of thinking is called idealization.

This honeymoon period can be very exciting for the new partner, too. After all, it’s really nice to have someone feel so strongly about you and to feel needed.

Problems start to arise, however, when reality sets in. When a person with BPD realizes that their new partner is not faultless, that image of the perfect, idealized soulmate can come crashing down. Because people with BPD struggle with dichotomous thinking, or seeing things only in black and white, they can have trouble recognizing the fact that most people make mistakes even when they mean well.

As a result, people with BPD may quickly go from idealization to devaluation—or thinking that their partner is a horrible person.

The key to maintaining a relationship with someone with BPD is to find ways to cope with these cycles and to encourage your partner to get professional help to cope with the disruptive symptoms and reduce problematic thinking. In addition to individual therapy, couples therapy can be helpful for both partners in the relationship.

Managing a Romantic Relationship With BPD

In addition to couples therapy, there are therapies that have been shown to be effective for a person with BPD, in terms of helping with relationships:

Dialectical Behavior Therapy

Dialectal behavior therapy (DBT) is a form of cognitive behavioral therapy that relates a person’s thinking to their behavior. There are four main skills taught in DBT, one of which is managing interpersonal skills.

Mentalization-Based Therapy

Mentalization-based therapy (MBT) is a therapy that focuses on helping someone make sense of what is going on in their mind and the minds of others.

Medications

There are currently no medications specifically approved to treat BPD, but doctors may prescribe medication to help improve certain symptoms of borderline personality disorder. Research suggests that some medications can help a person manage their anger, impulsivity, and depression.

On that note, though, it’s important to carefully weigh the side effects of a medication with its potential benefit. Talk to your doctor about which options might be right for you.

If Your Partner Has BPD

Being in a relationship with someone who has BPD can sometimes feel like being on an emotional roller coaster. While your relationship is bound to face some challenges, there are steps you can take to bring more stability to your connection.

Learn about BPD : Start by educating yourself about the symptoms and characteristics of borderline personality disorder. Knowing how to recognize the symptoms can help you respond more effectively.

: Start by educating yourself about the symptoms and characteristics of borderline personality disorder. Knowing how to recognize the symptoms can help you respond more effectively. Support your partner : Even if you don’t understand exactly what your partner is going through, be supportive and try to let them know that you hear and see them.

: Even if you don’t understand exactly what your partner is going through, be supportive and try to let them know that you hear and see them. Be patient : It takes time for therapy and medications to work. Try to be patient with your partner and recognize that setbacks are bound to happen.

: It takes time for therapy and medications to work. Try to be patient with your partner and recognize that setbacks are bound to happen. Set boundaries : Establish healthy limits on behavior, then be firm about maintaining those boundaries.

: Establish healthy limits on behavior, then be firm about maintaining those boundaries. Encourage treatment : Help your partner learn more about their treatment options and encourage them to adhere to their therapist’s recommendations.

: Help your partner learn more about their treatment options and encourage them to adhere to their therapist’s recommendations. Care for yourself: Supporting your partner is important, but it’s also vital to make sure that you are taking care of yourself.

While there will be bumps along the way, showing compassion and support can help set your relationship on a smoother path.

How BPD Affects Breakups

Many issues may arise when a relationship in which one partner has BPD ends. Because people with BPD have an intense fear of abandonment, a breakup can leave them feeling desperate and devastated.

Even if a relationship is unhealthy, a person with BPD can have trouble letting the relationship go. This is particularly true of long-term partnerships or marriages.

This is why it’s a good idea to have a support network for you and partner, especially if a breakup may occur. This network often includes a mental health professional.

Keep in Mind

It’s important to remember that while borderline personality disorder can create challenges in relationships, it is treatable. This means that while most people with BPD do experience residual symptoms even after time and treatment, in the long term, recovery and healthy relationships are possible.

If you have BPD, getting treatment for your condition is the first step. You can learn to manage your symptoms and develop healthier, happier relationships with therapy and support. If your partner has BPD, you can help by learning more about their condition, offering support, and maintaining good boundaries in the relationship.

The United States experienced a sharp increase in firearm mortality among youth in recent years, with firearms becoming the leading cause of death for children and adolescents by 2020. Beyond firearm deaths, there are many more youth who survive gunshot wounds or are otherwise exposed to gun violence, which can lead to negative behavioral health outcomes. For example, increased youth suicide risk has been linked to communities exposed to school shootings. School shootings in the U.S. have increased in prevalence over time, as has exposure of school-aged children to these shootings, up from 19 per 100,000 school-aged children from 1999-2004 to 51 per 100,000 from 2020 to 2024.

The new Trump Administration has revoked multiple gun safety initiatives in the interest of preserving Second Amendment rights. These initiatives include dismantling the School Safety Committee, an Executive Order to review and revise firearm regulations by the Bureau of Alcohol, Tobacco, and Firearms that may infringe on Second Amendment rights, and the removal of the former Surgeon General’s advisory that identified gun violence as a public health crisis.

This brief explores the impacts of gun violence on children and adolescents (ages 17 and below) and current policies affecting gun accessibility and safety. Key findings include:

Firearm death rates among children and adolescents increased 46% from 2019 to 2021, primarily driven by gun assaults. From 2021 to 2023, the firearm death rate has held steady at 3.5 per 100,000 children and adolescents. The increase in gun deaths during the pandemic is most pronounced among Black and Latino youth, among which gun assaults also account for the majority of firearm deaths.

Nonfatal firearm injuries are two to four times more likely to occur than fatal ones, and Black youth are much more likely than their White peers to be injured by or exposed to a gun violence incident.

Exposure to gun violence can have severe adverse effects on the mental health and well-being of children and adolescents, including increased likelihood of depression, PTSD, anxiety, and poor academic performance.

The new Trump Administration has rolled back multiple Biden-era gun safety policies. Simultaneously, access to mental health and trauma support may be impacted by federal budget cuts and restructuring.

How have firearm deaths changed in recent years among children and adolescents?

Firearm-related deaths have increased among children and adolescents since the pandemic began, with seven children per day dying by firearm in 2023. From 2013 to 2023, nearly 21,000 children ages 17 and younger died by firearm. During this period, firearm death rates gradually rose until 2017, then slowed through 2019, before sharply rising with the onset of the pandemic and holding steady in 2023 (Figure 1). From 2019 to 2023, the firearm death rate among children and adolescents increased by 46% (from 2.4 to 3.5 per 100,000). This translates to seven children per day dying by firearm in 2023.

Recent increases in firearm deaths were driven by gun assaults, which accounted for nearly two out of three firearm deaths among children and adolescents in 2023. Gun assault deaths among children and adolescents have increased over the past decade, resulting in 1,622 deaths in 2023 (Figure 2). Leading up to the pandemic, gun assaults made up about half of all child and adolescent firearm deaths. However, from 2019 to 2023, the share of these firearm deaths attributed to gun assaults grew from 54% to 63%.

Among child and adolescent firearm deaths in 2023, 29% were suicides and 5% were accidental. Suicides by firearm have increased over the past decade among children and adolescents, peaking in 2021 with 827 deaths (Figure 3). Suicides by other means, however, have consistently declined since 2019. In 2023, firearms were involved in 47% of total suicide deaths among children and adolescents.

How do youth firearm deaths vary by demographic characteristics?

Firearm death rates have sharply increased among Black and Hispanic children and adolescents since the pandemic began. In 2023, the rate of firearm deaths among Black youth was 11.7 per 100,000 – substantially higher than any other racial and ethnic group and over four times higher than White youth (Figure 4). Additionally, from 2018 to 2023, the rate of firearm deaths nearly doubled among Black youth and increased by 73% among Hispanic youth. While firearm death rates for American Indian and Alaska Native (AIAN) youth fluctuated over the same period, they remained higher than the rates of their White, Hispanic, and Asian peers throughout the period. White youth experienced relatively stable and lower firearm mortality rates from 2018 to 2023, while Asian youth had the lowest firearm mortality rates across the period (Figure 4).

The recent increases in firearm deaths among Black and Hispanic children and adolescents were primarily driven by gun assaults. Since the onset of the pandemic, the gap in gun assault death rates between Black and White children and adolescents has significantly widened. The gun assault death rate among Black youth grew from 4.9 to 10.3 per 100,000 between 2018 and 2022, dropping slightly to 9.7 in 2023. Among White youth, it remained steady and below 1.0 per 100,000 (Figure 4). The gun assault death rate among Hispanic youth doubled 0.9 to 2.0 per 100,000 between 2018 and 2022 before dropping slightly to 1.8 per 100,000 in 2023.

In 2023, Black youth accounted for 46% of all youth firearm deaths although they made up only 14% of the U.S. youth population (Figure 5). From 2018 to 2023, the share of firearm deaths attributed to Black children and adolescents grew from 35% to 46%; and the share attributed to Hispanic children and adolescents grew from 16% to 19%.

Firearm death rates for male children and adolescents are over four times higher than their female peers. From 2018 to 2023, the rate of deaths due to firearms increased by 53% among male children and adolescents but remained lower and stable among females (Figure 6).

Among firearm deaths, suicides by firearm are more common among adolescents compared to younger children, while accidental gun deaths are more common among younger children than adolescents (Figure 7). Gun assaults accounted for roughly two-thirds of firearm deaths among both adolescents and younger children in 2023. The second most common type of firearm death among adolescents was firearm suicides (32%), and among younger children was accidental gun deaths (21%).

Firearm death rates among children and adolescents vary considerably by state; however, almost all states have seen growth in these death rates in pandemic years. From 2020 to 2023 the states with the highest firearm death rates among children and adolescents were the District of Columbia, Mississippi, and Louisiana (10.3, 9.0, and 8.8 per 100,000 respectively for combined years, 2020-2023. The District of Columbia was also among the states with the highest school shooting exposure rates among school-aged children and adolescents in the 2020-2024 period (356 per 100,000, respectively). The states with the lowest firearm death rates were Massachusetts, New Jersey, and New York (0.7, 0.9, and 1.1 per 100,000 respectively for combined years, 2020-2023). Almost all states experienced an increase in firearm death rates from pre-pandemic to pandemic years, with the largest changes seen in Nebraska, Connecticut, and North Carolina (125%, 100%, and 100% respectively) (Figure 8).

What do we know about nonfatal firearm injury exposure among children and adolescents?

The number of nonfatal firearm injuries far exceeds the number of firearm fatalities among children and adolescents. However, estimates vary, with research suggesting nonfatal firearm injuries occur anywhere from two to four times more often than firearm fatalities. Recent data also indicate that since the pandemic began, nonfatal firearm injuries among children and adolescents have increased. The majority of youth nonfatal firearm injuries are a result of assaults.

Many children and adolescents are exposed to gun violence, even if they are not directly injured. Data on exposure to gun violence among youth is generally limited. However, a recent KFF analysis found that 51 per 100,000 U.S. school-age children were exposed to a school shooting from 2020-2024. Additionally, a CDC analysis found that in 34% of unintentional child and adolescent firearm deaths, at least one other child was present during the incident. Prior data from the National Survey of Children’s Exposure to Violence found that 8% of children and adolescents were exposed to a shooting in their lifetime, with a higher share (13%) reported among adolescents (ages 14-17). Further, in a recent KFF poll, 17% of adults in the U.S. reported witnessing someone being injured by a gun.

Black children and adolescents are more likely to experience firearm injuries and exposures than their White peers.Leading up to the pandemic, Black and male children and adolescents were more likely to experience nonfatal firearm injuries than their peers. This disparity among Black youth firearm injuries and exposures has been exacerbated since the pandemic began. In general, children of color are more often exposed to gun violence than their White peers. Children living in areas with a high concentration of poverty are more likely to experience firearm-related deaths, and poverty disproportionately affects children of color.

How does gun violence affect the mental health and well-being of children and adolescents?

Gun violence can adversely affect the mental health and well-being of children and adolescents. Exposure to gun violence is linked to post-traumatic stress disorder and anxiety, in addition to other mental health concerns among youth. Gun violence may also lead to challenges with school performance, including increased absenteeism and difficulty concentrating. In response to indirect gun violence, such as witnessing a shooting or hearing gunshots, many children and adolescents report feeling sad, anxious, or fearful. Children and adolescents are exposed to gun violence in multiple ways, outlined below.

Neighborhood and community violence . Many children and adolescents experience violence within their communities. Firearm homicides occurring within an adolescent’s community have been linked to anxiety and depression among adolescents, particularly for females. Other analyses have similarly found an association between incidents of neighborhood firearm homicides and poor mental health outcomes among youth.

. Many children and adolescents experience violence within their communities. Firearm homicides occurring within an adolescent’s community have been linked to anxiety and depression among adolescents, particularly for females. Other analyses have similarly found an association between incidents of neighborhood firearm homicides and poor mental health outcomes among youth. Suicide . Suicides are the second leading cause of death among adolescents and many suicides involve a firearm. Research has found that access to firearms, particularly in the home, is a risk factor for suicide deaths among children and adolescents. Nearly half of suicide attempts occur within 10 minutes of the current suicide thought, further underscoring access to firearms as a risk factor for suicide.

. Suicides are the second leading cause of death among adolescents and many suicides involve a firearm. Research has found that access to firearms, particularly in the home, is a risk factor for suicide deaths among children and adolescents. Nearly half of suicide attempts occur within 10 minutes of the current suicide thought, further underscoring access to firearms as a risk factor for suicide. Domestic or intimate partner violence . Women and children are often the victims of intimate partner violence, which may involve firearms. The presence of a firearm in the home is linked to the escalation of intimate partner violence to homicides. Even when firearms are not used, they may serve as a means of threatening and intimidating victims of domestic violence.

. Women and children are often the victims of intimate partner violence, which may involve firearms. The presence of a firearm in the home is linked to the escalation of intimate partner violence to homicides. Even when firearms are not used, they may serve as a means of threatening and intimidating victims of domestic violence. Mass shootings.Although mass shootings, including school shootings, account for a small portion of firearm-related deaths, they can negatively impact the mental health of children and communities at large. Research has found that youth antidepressant use and suicide risk increased in communities with exposures to school shootings. Additionally, a survey prior to the pandemic found that the majority of teenagers and their parents felt at least somewhat worried that a school shooting may occur at their school. School shootings are on the rise, with the U.S. average yearly rate of student exposure to a school shooting increasing threefold over time (from 19 per 100,000 students in 1999-2004 to 51 in 2020-2024). In response to school shootings, nearly all schools practice active shooter drills, which may have a negative psychological impact on participants. Although research is limited on how mass shootings affect individuals not directly exposed to them, current literature suggests that information and knowledge of mass shootings may be linked to increased levels of fear and anxiety.

Youth survivors of firearm injuries are at increased risk of mental health and substance use issues, in addition to chronic physical health conditions. An analysis of commercially insured children and adolescents found that, in the year following a firearm injury, survivors were significantly more likely to experience psychiatric and substance use disorders compared to their peers. Additionally, the increases in psychiatric disorders were more pronounced among youth with more severe firearm injuries compared to youth with less severe firearm injuries. Youth gunshot survivors are more likely to utilize mental health services following their injury compared to their uninjured peers. However, a study of youth survivors enrolled in Medicaid found that more than three out of five survivors had not received mental health services within the first six months following their injury.

Negative mental health impacts can extend to the family members of youth gun violence victims.Parents, particularly mothers, of youth firearm-injury survivors had an increase in psychiatric disorders and mental health visits in the year following the firearm incident, based on an analysis of commercially insured individuals. These increases in psychiatric disorders and mental health visits were more pronounced among families of youth firearm fatalities.

Gun violence disproportionately impacts Black children and adolescents, leaving them more vulnerable to negative mental health outcomes. In addition to increased assaults, firearm suicides, and exposure to community violence, Black communities are disproportionately exposed to police shootings. Research found that Black people living near the scene of a police killing of an unarmed Black individual experienced worsened mental health in the months that followed. Separately, despite mental health concerns among Black youth injured by gun violence, research on mental health service utilization in the months following a firearm injury is mixed, with one study finding higher utilization among Black youth compared to their White peers, and another study finding the reverse. Historically, Black individuals are less likely to receive mental health treatment and face additional barriers to care, such as the lack of culturally competent care.

What policies address child and adolescent exposure to gun violence and poor mental health?

Gun control debates are deeply divided politically in the U.S.; but beyond gun control, other approaches seek to reduce the impact of firearms on health, for example, through safe storage practices.Safe storage and child access prevention provisions have been linked to a reduction in adolescent firearm homicides and non-fatal gun injuries. These provisions vary widely across states; some states have multiple provisions, while others have none. Some states have also enacted unique approaches to promote gun safety. For example, beginning with the 2023-2024 school year, local education agencies in California are required to notify parents annually on the safe storage of firearms; and some states provide tax rebates on safe storage devices. The Biden-Harris administration put forth additional steps to promote safe storage of firearms, including guidance from the U.S. Department of Justice, which was taken offline during the current Trump Administration. A KFF poll found that 44% of parents with children under the age of 18 have a gun in their household. Among parents with guns in their home, about one-third said a gun is stored loaded (32%) or stored in an unlocked location (32%) (Figure 9). More than half of parents (61%) said any gun in their home is stored in the same location as ammunition. The KFF poll also found that only 8% of parents said their child’s pediatrician talked to them about gun safety.

The Trump Administration is rolling back some Biden-era policies aimed at addressing gun reform and expanding youth mental health services for children and adolescents. During the Biden Administration, the Bipartisan Safer Communities Act (BSCA) was passed in response to increasing gun violence. The BSCA outlined provisions on gun reform and improving access to youth mental health services, including through schools. However, in May 2025, the Trump administration canceled $1 billion in BSCA grant funding for school-based mental health services. Gun safety groups fear that President Trump will attempt to further weaken or eliminate the BSCA. Additionally, other measures that may address youth mental health and gun violence trauma, including the rollout of 988, may also be in jeopardy. Under the Trump Administration, the Department of Government Efficiency (DOGE) laid off about a quarter of the 988 Hotline’s digital communications team. New federal funding freezes have also been put in place on prevention work by federal authorities to stop terrorism and mass shootings.

Gun violence disproportionately affects many children and adolescents of color, particularly Black children and adolescents, and this disparity has grown since the pandemic. Children and adolescents of color may also face added barriers to mental health care in light of long-standing cultural inequities and a lack of culturally informed care. In years prior, mental health initiatives aimed at Black and Latino people were introduced in Congress and SAMHSA announced funding opportunities to create a Behavioral Health Center of Excellence aimed at improving behavioral health equity for Hispanic and Latino communities. SAMHSA’s funding, however, has been cut by the Trump Administration by approximately $11.4 Billion, preventing the entity from using money that was previously earmarked for mental health and substance use disorder resources.

Gun violence can lead to increased mental health and substance use concerns. The recent increase in child and adolescent firearm injuries and deaths come at a time when concerns about youth mental health have grown but access to and utilization of mental health care may have worsened.

View image in fullscreen Photograph: Guardian design

A chill wind swept through Europe this summer. On the continent, far-right parties rose triumphantly in the EU elections, hoisted not just by the grumbles of older xenophobes but on the shoulders of young men. When news crews went out on the streets to train their cameras on these extremists in France, Germany, Finland and the Netherlands, they found no blackshirts, just barbershop trims and Zara chinos worn by young men, enthralled by dreams of ethnonationalism and a return to the values of the 1980s or the 1940s or some other period long before their birth. Then, in Britain this weekend, gangs of mostly young far-right men marauded through northern towns, attacking mosques and accommodation for asylum seekers. The nationalist right is rising once more on the tides of gelled-backed hair and Nike swooshes.

A similar transformation could befall America in November. Until now, twentysomething voters were a thorn in Donald Trump’s side, opposing him robustly in previous elections and making their resistance corporeal as leaders in the Women’s March, Black Lives Matter protests and climate movement. Yet recent election polls suggest that while young women remain committed to the cause, there has been a tremulous withdrawal from young men. In 2016, 51% of young men identified with or leaned toward the Democratic party. By last year, it was down to 39%. Young men now favor Republican control of Congress and their support for Trump has grown since 2020.

The Democratic strategist James Carville (he who told Bill Clinton “it’s the economy, stupid”) has been warning Democrats that the party’s eroding numbers among young men and young people of color are “horrifying”: “We’re not shedding them; they’re leaving in droves.”

Of course, many of these fears were emerging when Joe Biden, an octogenarian white man, was still the presumptive Democratic nominee. But while early polling suggests that overall, gen Z is excited by Kamala Harris’s likely nomination, she hasn’t made much impact on gen Z men. Research by the Young Men Research Initiative (YMRI), a group set up in recent months to observe this unexpected drift, shows that men aged 18-29 are split 32% for Harris and 33% for Donald Trump, with Robert F Kennedy Jr taking 15%. This is an almost identical split to when Biden was the frontrunner.

Young men used to vote more like young people: left. Now they might start voting like men: right. What changed?

View image in fullscreen People wait for Donald Trump to speak at a Pennsylvania rally in 2016. Photograph: John Locher/AP

Some pollsters believe we are witnessing a new politics of resentment – that young men feel #MeToo has gone too far, that feminism has left them behind, and that they can only see a home for themselves in a testosterone-fuelled Republican party.

Others – including Richard Reeves, head of the recently founded and influential American Institute for Boys and Men – say this isn’t a cultural issue. While a small, loud minority of men might have become more extreme in their views on feminism, most are responding to other economic and social factors that have meant they have lagged behind women for some time. Young men statistically are more depressed, financially worse off and less educated than young women, and looking for electoral answers. “This is less about young men being pulled towards the right than it is about them being pushed away from the left,” Reeves says.

Blue-collar workers, Hispanic voters in Florida, white married women: Democrats have blundered before in assuming they had certain demographics locked up only to find they had taken them for granted. Unless the party can work out why it’s losing young men and how to win them back, Democrats may wake up to a cold new dawn in November, as Europe did in June.

‘A very scary time’: the politics of resentment

In 2018, a gaggle of the White House press corps asked Trump for his opinion on the allegations that Brett Kavanaugh, his nominee for the supreme court, had sexually assaulted Christine Blasey Ford when she was 15 years old. Trump, almost drowned out by the whirring blades of Marine One, could only offer superlatives in response. “High quality”, “top student”, “a great judge”. The reporters sounded desperate: what does it say to boys that someone facing such a serious accusation is still being considered for the supreme court?

“Well, I say it’s a very scary time for young men in America,” Trump replied. “You could be somebody that was perfect your entire life and somebody could accuse you of something … and you’re automatically guilty.”

Trump had dismissed his own boasts of sexual assault as “locker room talk” during his 2016 campaign, but now he was making his pitch directly to the locker room. Having harnessed the racial resentment of white voters who felt society had become too diverse, could he do the same with young men who felt society had become too feminized?

View image in fullscreen Kamala Harris greets supporters at South Carolina State University in February. Photograph: Brandon Bell/Getty Images

The answer was a resounding no. One month later, in the midterms, the Democrats won 72% of young people’s votes overall, including at least 57% of young male voters. In 2020, Biden only won the popular vote narrowly but among young people (men and women aged 18-29), it was another landslide: a 24-point win. Time Magazine declared that young voters had reshaped “the contours of American politics” – if you were young, you were a Democrat.

The feeling was that members of gen Z share a unique set of economic circumstances (a lifetime of renting, high student loans), will suffer most from environmental catastrophe, and are racially diverse and socially aware. A 2022 Gallup poll in the US found that more young people aged 18-29 had a favorable view of socialism than of capitalism. These sentiments have filtered into our cultural image of young people, too. Google images of gen Z and you’ll see groups of gender-ambiguous, ethnically diverse, septum-pierced activists clutching a smartphone in one hand and a protest sign in the other.

Yet Trump’s dog whistles and Kavanaugh’s eventual appointment to the supreme court led to an embryonic neo-chauvinism. Kavanaugh, describing his confirmation hearing “as a national disgrace”, seemed to support Trump’s read that he was a victim of his gender and nod towards a politics of grievance.

A few years later, Kavanaugh was instrumental in overturning Roe v Wade, destroying the hard-won freedoms of women and transforming the Democratic party – and its sometimes reluctant, whispered pro-choice position – into an explicitly pro-abortion-rights party. It also entrenched a situation in which young women passionately hated Trump; about 74% of young women had a negative view of him immediately after Kavanaugh’s confirmation, compared with 57% of young men.

So if Democrats were clearly the party of young women, Republicans tried to take advantage of being the de facto party of young men.

Tucker Carlson, the most powerful commentator on the right at the time, monologued nightly on Fox News about their plight.

“[Young men] know that their lives will not be better than their parents, they’ll be worse,” he said. “Yet the authorities in their lives, mostly women, never stop lecturing them about their so-called privilege. ‘You’re male! You’re privileged.’ Imagine that. Try to imagine an unhealthier, unhappier life than that. So a lot of young men in America are going nuts. Are you surprised?”

It was the night after the Highland Park Independence Day parade shooting, and Carlson was explaining why a 21-year-old man like Robert Crimo might want to murder seven people at random.

View image in fullscreen Tucker Carlson, the US representative Byron Donalds, Donald Trump, Senator JD Vance, and House speaker Mike Johnson at the Republican convention this year. Photograph: Chip Somodevilla/Getty Images

The Republican senator Josh Hawley, who raised his fist in salute to rioters at the US Capitol on January 6, picked up the baton in Congress and in his book Manhood: The Masculine Virtues America Needs. “Why don’t you turn off the computer and log off the porn and go ask a real woman on a date – how about that?” the senator yelled at the rightwing Turning Point USA conference.

The message was amplified by Trump-supporting figures outside the party too, chief among them Andrew Tate, the misogynist podcaster with a huge following among teenage boys.

“Tate’s telling men that they are in a worse position than they should be because of feminism,” says Matt Shea, the journalist and documentary director who spent four years with Tate and hundreds of his young fans for two BBC documentaries and a new book, Clown World.

He says Tate’s skill is in linking a feeling of incompetence in the dating world with a political impotence. Tate promotes the myth that the “sexual marketplace is dominated by a small number of alpha males, and that other men are sexually starved – and the reason for that is that women have more choice now”, says Shea.

While there have always been sexually frustrated men, Shea believes that “now those men feel that they’re owed sex and have coagulated into a political movement that lays the blame on society for denying it to them”.

Daniel Cox, a senior fellow at the American Enterprise Institute, a free-market thinktank, agrees we need to look “upstream from politics” to relationships to see why men are becoming less progressive. “Women are less willing to overlook the same kinds of qualities that maybe their mothers and grandmothers were … in terms of what [men] need to contribute to a romantic partnership, the emotional labor that they need to do. Some young men have a kind of zero-sum mentality where if women are gaining, they’re losing.”

In Germany, far-right candidates are already trying to capitalize on men’s supposed dating woes. The controversial AfD candidate Maximilian Krah posted on TikTok saying: “One in three young men in Germany has never had a girlfriend. Are you one of them? … Don’t watch porn, don’t vote green, go outside into the fresh air … Real men stand on the far right … That’s the way to find a girlfriend!”

Within days of being re-elected to the European parliament this year, he was expelled from his party after making sympathetic comments about the SS.

Unease about gender roles is reflected in polling. A July poll by YMRI found that 65% of young men aged 18-29 agreed that “guys can have their reputation destroyed just for speaking their minds these days” – an eerie refrain of Trump’s Kavanaugh statement – and 52% of men under 30 agreed that “things are generally better when men bring in money and women take care of the home and kids”.

Armed with this sort of feedback, it seems Trump has been heavily courting the young, resentful male vote. He has attended Ultimate Fighting Championship bouts until the early hours, walking out to Kid Rock’s American Badass. He has lately worked hard to position himself as the crypto candidate and is heavily promoting himself on TikTok. When Kid Rock, Hulk Hogan and Dana White, CEO of UFC, introduced him at the Republican convention, Kid Rock screamed at everyone to put their fists in the air and shout “fight!” as Trump had done after the attempt on his life. Trump even attended a sneaker conference to launch his own golden hi-tops.

There are millions of progressive young men who won’t be interested in his proposition. LGBTQ+ men, for example, remain solidly progressive, as do young Asian American voters. But for others, Cox says, Trump’s effort could work. “Logan Paul just had Trump on his show. He’s got over 7 million followers. Some young men who are not very political might say, ‘Oh, hey, you know, Trump showing up, he’s talking, he’s engaging. I kind of like this.’”

View image in fullscreen Alex Pereira of Brazil poses for a photo with his team and the UFC commentator Joe Rogan in June in Las Vegas. Photograph: Jeff Bottari/Zuffa LLC/Getty Images

‘Shrugging shoulders, not raising fists’

Fortunately for Harris, for all the many headlines about Trump’s successful overtures to young men, the polls are laden with caveats. Harris’s support jumps dramatically when pollsters measure only young men who are registered to vote (from 38% to 52% in a head-to-head matchup, according to the YMRI poll), suggesting that if Republicans want to capitalize on their popularity with this group, they will have to get them registered to vote (something they have made much harder over the past 20 years). She also takes a lead over Trump among all young male voters if RFK Jr isn’t offered as an option.

The way in which age and gender overlap with race is also contested. Polling suggests a stark drop in support for Democrats in the past five years from both young Black men and young Hispanic men, with YMRI data showing both groups preferred Trump to Biden by a two-point and 19-point margin respectively. Harris changes things somewhat, but support for Trump remains high. “Young men, including men of color, are drifting away from the Democratic party,” says Shauna Daly, co-founder of YMRI, who conducted the research. “It’s just not reality if we don’t acknowledge that.”

But Mondale Robinson, founder of Black Male Voter Project, which exclusively works with Black men who haven’t voted in previous elections, is dubious. He says that before every election, some polls say Black men are becoming less progressive, and yet in the elections it never comes to pass. He points to Black men in Ohio voting in 2023 on women’s right to abortion “more than anybody, 88%, even by eight points more than Black women”.

What we do know is that women are becoming much more liberal. While the number of young men who identify as liberal has held pretty much steady around 25%, the number of young women who do soared in the space of a decade to almost 45%. A major Gallup poll unveiled by the Financial Times in January revealed that “women aged 18 to 30 are now 30 percentage points more liberal than their male contemporaries” in the US – a gap that opened up in just the last six years. (Polling found kindred patterns in the UK, Germany, South Korea and China.) Young women have become easily the most progressive generation in history – on abortion, healthcare, taxation and trans rights.

But the shift in young men’s political attitudes can’t be explained simply by young women moving leftwards. Nor is it simply a story about young men resenting them for it.

Richard Reeves – whose 2022 book, Of Boys and Men, has become a foundational text on what has gone wrong for young men in the country – is damning of framing that puts young men’s rightward turn in terms of UFC fights and incels, when he believes it’s about deep-seated inequalities of outcome in education, mental health and employment.

“I want to talk about why only 60% of Black boys graduate high school on time in Michigan, or the fact that the share of male teachers has gone from 33% to 23%. Or that we’ve lost more than half the men who work in social work and psychology,” he says. “I’d want to talk about that rather than, for example, whether the Barbie movie was unfair on Ken.”

View image in fullscreen Harris in Atlanta last week. She has the support of 32% of young men. Photograph: Edward M Pio Roda/EPA

He says people are misinterpreting the polling. “It’s not enthusiasm for the reactionary right, it’s a sense of being taken for granted by the left. There are more young men shrugging their shoulders than raising their fists.”

It’s true that there is now a growing gender gap in education; for every 100 bachelor’s degrees awarded to women, 74 are awarded to men. In many US cities, young women are earning more than young men and moving out of parents’ homes earlier than them.

Reeves is careful to say that improving conditions for men and boys should not mean slowing down similar efforts for women and girls. But he says that government institutions do have a tendency to purposefully avoid naming the problems young men face. Suicide is one of the clearest areas in which there is a huge gender divide – there’s a fourfold gender gap in rates for young people – and yet, says Reeves, “the CDC website breaks down suicide rates by every demographic except gender. Why? Why don’t the Democrats have a taskforce on male suicide when there are 40,000 deaths a year?”

He gives other compelling examples of how Democrats have failed to signpost their achievements to young men. Biden’s infrastructure bill – his key piece of legislative success – was a huge jobs creator for working-class men, “but the administration tied itself in knots not to say so”. Instead, it focused on the million women in construction initiative to ensure women got some of the funding. “That’s amazing. Now, er, where’s the million men into teaching initiative? … There are so many initiatives for women in Stem; why not one for men in teaching? Who is going to attack that?”

On the Democrats’ own website is a page titled “who we serve” that lists 14 different groups. Men are not among them.

Reeves believes there are some simple solutions – although he acknowledges they are “pallid” in terms of “the vividness” of Trump’s trips to UFC fights.

“I’ve been thinking about writing the speech Biden should give,” he said before Harris became the likely Democratic nominee. “It would talk about vocational training, technical high schools, all things that are massively pro-men. And rather than apologizing for it, he could just say, ‘These would be particularly helpful for young men even though of course we want more women to do it too.’ Then I would want him to say, ‘I’ve asked the White House gender policy council to stop only focusing on women and girls’ issues, but also focus on some issues of boys and men, starting with issues of Black men, education, mental health.”

Message testing by YMRI bears this out. Researchers asked two groups of men about the same hypothetical infrastructure bill, calling it “the Democratic Agenda for America” in one group and “the Democratic Agenda for Men” in the other. In another poll, they asked about a hypothetical female presidential candidate who promised one group to make history as the first female president, and the other group to focus on progressive policies like affordable housing and healthcare. There was “a 5-7 point swing in support, either an increase if you centered the policy agenda around men or a decrease if you focused on the historic nature of the candidate”, says Daly.

View image in fullscreen Pro-Palestine demonstrators at the University of California, Los Angeles, in April. Photograph: VCG/Getty Images

Perhaps the “white dudes for Kamala” and “Black men for Kamala” fundraising calls are early steps towards Democrats acknowledging men as an important voting bloc in 2024 (even if those calls were mostly for rich donors). Biden’s attempt at masculine swagger, telling Trump to “man up” and debate Harris, could be seen as a sop towards that kind of messaging too.

It’s not just about the message, though; it’s also about trusted messengers, says Robinson of Black Male Voter Project: “These young men don’t take marching orders from anyone.” He says turnout is a real issue, especially among non-college-educated Black men, among whom the distrust in both parties is so high that even having a Black candidate in Harris won’t make a difference. He says higher turnout can only come with grassroots organization – earning trust – that goes beyond election years.

“[Our organization] doesn’t do that ‘Washington DC told us this is what works’ shit with Black men. Black men are suffering from not having their basic needs met … The Black men we engage with have no delusion that their vote is going to fix everything that’s plaguing them. But they do understand that when a vote becomes the tool to address the hunger, it starts yielding fruit.” Or, as he later put it, “if they’ve got a racist police chief, they can unelect the fucking mayor.”

Reeves, however, says it almost doesn’t matter what the message is – the mere fact of someone from the Democratic party standing up and acknowledging men would be a huge shift. “Take someone like Jordan Peterson. His appeal does not lie in the brilliance of his policy proposals, or his advice. His appeal is simply in allowing a lot of young men to be heard. He says ‘I get it, you’re hurting’ and he fills stadiums with that message.”

Can Democrats win men without losing women?

Men, overall, are not the ones who are being legislated against. Over the past eight years, the Republican party, remade in Trump’s image, has cruelly gutted women’s right to abortion. It has decimated female representation at every level of government. It has given unwavering support to the police, even as police sexual assault against women reaches epidemic levels and police routinely murder Black women. They have emboldened the most misogynistic corners of the internet by putting forward a presidential nominee who has been found liable for sexual abuse, has bragged about sexual assault and rates women on a 1-10 scale (“in the same way that we do”, wrote the pick-up artist and alt-right blogger Roosh V after Trump won in 2016).

View image in fullscreen Trump supporters on election night in 2016. Photograph: Evan Vucci/AP

“The messaging of the Republican convention was a message of male supremacy, of female submission. Women are afterthoughts in reproductive policy, health policy, the proposed marriage policy of no divorce,” says Bonnie Honig, professor of culture, media and political science at Brown University and author of Shell Shocked: Feminist Criticism After Trump.

When women’s very safety is at stake, should the Democrats really be worrying about how to appeal to disaffected men?

First, Honig says, it’s a mistake to think of abortion purely as a women’s issue: “The loss of women’s rights is a loss for men.” She suggests that Democrats should start using the line “women’s health is not a women’s issue”, adding that “women who don’t have choices, in my opinion anyway, are not fun to live with”.

More broadly, she feels that the Democrats need to avoid falling into the young men v young women dichotomy laid out by the Republicans – and pollsters. “To over-extrapolate from these polls risks feminizing the Democratic party, which is what Republicans want to do, so that they can claim to embody a kind of masculinity that is fascist-forward.”

Republicans have used this gendered messaging before. “They made Obama into a representative of a kind of feminized liberal man,” Honig says. “With Biden, there was an objective fact of his age, but that was turned into saying he had aged out of any masculinity he might once have had. They did something quite similar to John Kerry, who was a war hero, but by the time they were done with him, he was just a guy who was married to a wealthy woman.”

Rather than trying to appeal to young men as an aggrieved demographic group, she suggests, Democrats should try to think beyond gender to the other economic, class and community groups young men are part of: unions, professions, students, parents. “I think by supporting the United Auto Workers, for example, [Democrats] are supporting men between the ages of 18 and 30.”

Three months out from the election, the political reality remains that Republicans have nothing to offer men legislatively, but lots to offer in messaging. The Democrats have lots to offer in policy but are afraid to say the “m” word.

But things can change quickly. After the far right performed so well in the European elections, Emmanuel Macron called snap French parliamentary elections – an incredibly risky strategy that paid off. Among voters 18-24, the far-right National Rally still did well, with 33% of first round votes. But the leftwing New Popular Front fared even better, winning 48%. It did so by promising to invest in public services, freeze prices, raise the minimum wage and embargo arms to Israel.

America is not in the same political reality as France, but its election is not a done deal either. Young men’s votes are still up for grabs. “Democrats are missing a huge opportunity to say that they see and hear the issues of a certain kind of young man,” Reeves says, “and that they are at least open to acknowledging them.”

By Sterling Davies | OBSERVER Staff Writer

For Terry Sharp, growing up in Queensbridge, New York in one of the nation’s largest housing projects – surrounded by domestic abuse, gun violence, and drug use – the door seemed closed on discussing the negative impact his environment was having on his mental health.

Although Sharp, now 34, knew from a young age that he struggled with depression, there was never a moment to stop and process the cause and the weight of it all. “I always dealt with feeling like there was something wrong with me or like I’m not enough,” he said. “I just didn’t know how to address it.”

Sharp moved to Sacramento in 2018, and his depression persisted. It wasn’t until he faced an all-time low that his approach to life shifted. In October 2022, Sharp was shot multiple times by police officers and was incarcerated for six months.

“They took money, they took my car. I couldn’t get the keys to my house,” Sharp said. I literally came out of jail with the clothes I wore in the hospital.”

Sharp’s story mirrors the mental health struggles of Black men across the nation. As of 2024, suicide is the second-largest cause of death for Black men between the ages of 15 and 24. And suicide rates for Black men are four times higher than for Black women.

Many African Americans, including Sharp, gathered June 29 at The OBSERVER’s “It’s OK Brotha” Mental Health and Resource Fair in Oak Park to discuss resources and advice surrounding Black men’s mental health. Throughout the event, men of color across different ages and backgrounds shared their mental health journeys, shedding light on the highs and lows.

“It’s OK” Brotha Event Photo Gallery Many African Americans, gathered June 29 at The OBSERVER’s “It’s OK Brotha” Mental Health and Resource Fair in Oak Park to discuss resources and advice surrounding Black men’s mental health. Throughout the event, men of color across different ages and backgrounds shared their mental health journeys, shedding light on the highs and lows. VIEW PHOTOS

The event, organized by The OBSERVER in support of Senior Staff Writer Genoa Barrow’s Head Space series, was supported by The County of Sacramento and the USC Annenberg Center for Health Journalism. The series featured more than 30 stories addressing the mental health needs of Black men. Several of the men featured in the series participated in the event, including social worker LaVontae Hill, local activist Stevante Clark, Jabari Rahotep and others.

The rise in suicide and mental illness underscores the need for Black men to join the discussion on declining mental health as a first step towards minimizing the deadly consequences.

Within the African American community, Black men often feel pressured to suppress their emotions and remain “stone-faced” as Cameron Sykes, 34, puts it. Sykes, a member of Stop Stigma Sacramento, a county-funded mental health initiative, spoke at the event on how older generations of Black men have passed down the notion of needing to withhold emotion, whether positive or negative, closing the conversation on mental health altogether.

“When I was young, [mental health] wasn’t really emphasized at all,” Sykes said. “We were actually encouraged to not talk about it, whether it was our fathers or coaches or something like that.”

For Black men, exposing feelings of despair can be viewed as weakness and call into question their manhood, Sykes said. Oftentimes, suppressing emotions leads to suppressing childhood struggles, creating larger issues down the road.

“It’s a different trauma for Black children,” Sykes added. “Growing up in underfunded neighborhoods, we’re shown stuff that we’re not supposed to see … having absent family members, having brothers or sisters shot. Those are the types of things that we see in the Black community far more than you see in other community groups.”

Struggling with trauma internally can naturally lead to mental illness. Suppressing emotions, however, is often interpreted as being resilient, especially within the Black community. This creates a harmful representation of resilience, which more and more voices hope to rewrite.

Paul Moore, the partnership development manager for ONTRACK Program Resources, a nonprofit dedicated to improving services for diverse communities, spoke at the resource fair about his mental health journey. Moore, 60, developed anxiety after incarceration due to substance use. “I think a lot of people who were in jail develop some form of anxiety because you’re constantly looking over your shoulder, and that continues once you’re out,” he said.

Moving forward was a matter of being strong enough to reach his goals without distractions, Moore said. “I don’t quit, and nothing was going to get in the way of me wanting to help others with their mental health, so I became resilient enough to push past the distractions.”

That resilience led Moore to share his struggles with anxiety and help others do the same. He now facilitates ONTRACK’s support group for Black men and continues to voice the importance of normalizing discussions on mental health.

The event also brought various speakers who highlighted the necessity of Black-focused spaces for African American men to gather and feel a sense of understanding.

Brothers Marichal and Rodney Brown spoke to share how they use their barbershop as a place for young Black men to feel comfortable and open up about themselves and their mental health.

Marichal and Rodney Brown shared their unique approach to mental health by offering free therapy sessions while cutting clients’ hair at their shop, Hairitage Barber Shop. This initiative was showcased during The Sacramento Observer’s ‘It’s Ok Brotha: Black Men’s Mental Health & Resource Fair’ held at the Oak Park Community Center on Saturday, June 29, 2024. (Photo by Madelaine Church)

The Browns, owners of HAIRitage Barbershop on Broadway and partners of The Confess Project of America, were “raised in a barbershop.” Their father was a barber and owned a shop in Sacramento. They grew up seeing how barbershops serve as a space for “Black men to come and have conversation away from society,” Marichal, 59, explained. “When you’re amongst your people, you can kind of relax.”

When the Browns took over their father’s business and later opened their own barbershop, they continued to reinforce this idea and created a space where young Black men could learn from the experiences of people they relate to. Instead of turning to social media or relying on their own thoughts, they hope more young adults can open up to barbers and mentors who understand them, but more importantly, want to help.

For Black teenagers finding the right person to talk to becomes increasingly essential, but also increasingly difficult. Lorreen Pryor, Brandon Trowel, Carlos Simpson Jr., Fxxi Irvin, and Da’Monik Millan of the Black Youth Leadership Project spoke at the resource fair. During their panel, they discussed how many traditional institutions and safe havens, such as schools and homes, lack people who are willing to talk and listen to those who need help, which leaves children to deal with issues on their own.

“Kids left to their own devices don’t always yield positive results,” Trowel explained. “We need to do our part as elders to make sure we get our kids to these safe spaces where positive growth can be encouraged … that they have a community of Black men who were once Black boys that they can rely upon.”

When there are more opportunities for African American men to find someone to talk to, whether it be in a private or group conversation, it normalizes mental health discussions for Black men and allows young adults to discover the form of help that works best for them.

“I don’t think there’s a one-stop-fits-all type of thing,” said Pryor, founder and CEO of Black Youth Leadership Project. “Everyone has to be judged on their own merits.”

As for Terry Sharp, he “created a new value system” for himself, and has since begun helping formerly incarcerated men find stable resources, jobs, and housing. “I just had to really dig and find myself within,” he said.