I was in Congress when the ACA was negotiated and signed into law. While we were forced to accept less than the universal health care we wanted, we secured protections that have saved tens of thousands of lives: ending discrimination against people with preexisting conditions, allowing young adults to stay on their parents’ insurance while they find their financial footing, and guaranteeing that every plan covers basic, essential care.

This current fight over premiums is showing, once again, the flaws in our health care system.

Republicans have made clear that they have no appetite for meaningful reforms that would lower costs and increase access, like Medicare for All. They have been unable to devise any serious alternative to the ACA, instead advocating for failed policies like high-deductible plans and direct payments to Health Savings Accounts. They have subjected the ACA to death by a thousand cuts, weakening it at every opportunity. The fight around these tax credits is more of the same, tired playbook.

Realistically, Republican opposition means that larger reforms are unlikely in this current Congress. But that is why there is an urgent need to extend the enhanced tax credits, because they are the only thing standing between hundreds of thousands of Coloradans and skyrocketing health care bills. Now, notices are going out across the state warning families exactly what they’ll be forced to pay without Congressional action. The numbers are staggering.

According to the Colorado Division of Insurance, 225,000 people will face an average premium increase of 101%, which means their monthly costs will more than double overnight.

For many of my constituents, this is a real financial crisis. In my district, a family of four making $128,000 are seeing their premiums for a standard silver plan jump by $14,000 next year. That¶¶Ňőap not a number any household can absorb without making painful choices.

Let me be clear: this crisis is completely avoidable.

If Congress simply extended the enhanced ACA tax credits, something Democrats have been fighting for all year, these increases would be softened dramatically. In fact, the premium spike would be cut by more than 80%, and lower-income families wouldn’t see any increase at all. And nationwide, the nonpartisan Congressional Budget Office estimates that continuing these credits would keep over 5 million Americans from losing their health insurance.

Republicans know this, and still, they refuse to take the easy step of extending these tax credits to give us time to negotiate a long-term solution.

Meanwhile, the consequences will ripple across Colorado’s entire health care system. If thousands of Coloradans lose coverage, hospitals will be forced care for more people who cannot afford to pay. Those costs will then get passed to people with employer-based insurance. That means higher costs even for those who don’t get care through the marketplace. If Congress doesn’t act, our whole health care system will be at risk.

As the top Democrat on the Energy and Commerce Health Subcommittee, I’ve been demanding for months that my colleagues across the aisle join us in extending these tax credits. But open enrollment has already begun, and families need certainty before the new year.

Congress can solve this problem today. We can vote to extend the enhanced tax credits and prevent these devastating premium spikes. We do not lack a solution; we lack political will from my Republican colleagues.

Time is running out. I will keep fighting for my Republican colleagues to put politics aside and join me in lowering costs for Colorado families.

U.S. Rep. Diana DeGette represents Colorado’s 1st Congressional District.

To send a letter to the editor about this article, submit online or check out our guidelines for how to submit by email or mail.

Marketplace customers face a double hit this year. The monthly “sticker price” of health insurance is rising, typically due to the aging population and increased use of expensive care, including high-cost medications. And households will have to pay a larger share of that monthly cost than they have since the pandemic as the tax credits that subsidize insurance purchases revert to pre-COVID levels.

The average person who receives subsidies to buy their insurance through , the state-run marketplace, will have to pay 101% more in 2026 after accounting for both factors, according to the Division of Insurance.

The enhanced subsidies lowered the percentage of a person’s income that they had to put toward premiums. For example, an individual earning $35,000 per year previously had to pay 3% of their income, or $1,033 annually, for their insurance, . Next year, they’ll have to pay 7.5%, or about $2,615.

People earning more than four times the federal poverty line, or about $128,000 for a family of four, won’t receive any subsidies next year. For a family of four at that income level in Denver, premiums for a silver plan would rise $14,000, with greater increases in rural areas. The enhanced subsidies also phased out as income increased, but .

The division estimated about 75,000 of the 335,000 people who buy insurance on the state marketplace will opt to go without coverage, leaving them exposed to high medical bills if they have an unexpected illness or accident.

Jessica Nelson, of Denver, said going without insurance isn’t an option for her family, so they’ll have to choose a less generous plan, take on more work to raise their incomes, or cut non-essential spending. Both she and her husband are self-employed, and neither wants to return to corporate jobs for the sake of insurance.

But at least they can make the numbers work, she said.

“I just keep thinking about the people who are going to be losing their insurance,” she said.

The upcoming lapse in tax credits is driving the now four-week-long government shutdown. Democrats say that any deal to reopen the government should include an extension of the enhanced subsidies, while Republicans say any extension has to come after a deal to fund federal agencies.

Mannat Singh, executive director of the , cast doubt on Republicans’ willingness to extend the subsidies when the government reopens.

Allowing them to expire helped bring down the cost of extending tax cuts for top earners through H.R. 1, she said. The sweeping tax law is known as either the “big beautiful” or “big ugly” bill, depending on the political leanings of the person speaking. All of Colorado’s Republican delegation voted for the bill, while all of the Democrats voted against it.

“They knew this devastation was coming and have failed to protect Coloradans from massive increases in insurance premiums,” she said in a news release. “Congress needs to take action now to extend enhanced premium tax credits.”

If Congress extended the higher subsidies, premiums would rise about 16%, and lower-income people wouldn’t face any increase, according to the state insurance division.

Theoretically, lawmakers could still act, but the window is closing rapidly. Open enrollment starts Saturday, and people who want coverage in January need to choose a plan by Dec. 15.

Typically, the state would have released this information weeks ago after determining whether rates that insurers submitted over the summer were reasonable.

The legislature passed a bill in August to try to reduce rates, requiring insurance companies to submit a new set of numbers. The Division of Insurance then asked them to lay out how much lower their rates would be if Congress extended the subsidies. Those rates are now irrelevant, though extending the subsidies could limit how much of the increase customers have to pay.

The that extending the subsidies would increase the number of people with insurance by 3.8 million, but also raise the deficit by $350 billion over the next decade.

“These premium increases are going to create impossible decisions for families across the state. We have sounded the alarm bells at every turn, but Congress’ refusal to act means that Coloradans will be left with unacceptably high health insurance bills during a tightening time in the economy,” Insurance Commissioner Michael Conway said in a news release.

Nationwide, KFF estimated premiums would rise an for people who received subsidies. Other estimates put .

The cost of job-based insurance also typically rises annually. In 2025, workers had to pay about 6% more in annual premiums than they did in the previous year, . Information about 2026 premiums isn’t yet available.

The legislature reduced the average impact from about 174% to 101% by appropriating $75 million to directly subsidize customers and by putting up to $50 million toward the state’s reinsurance program, Conway said.

Reinsurance acts as a backstop for insurers, covering some of the cost of their most expensive customers’ care. That means insurance companies aren’t on the hook for as much money and can charge lower premiums, which in turn saves the federal government money it would have paid out in tax credits.

The federal government allowed the state to use those savings to pay for reinsurance, but with lower tax credits, the savings are also lower. The legislature’s appropriation partially replaced the federal money Colorado won’t receive.

Though the legislature’s efforts helped, the increase in premiums on the individual market will affect health care providers and people with job-based insurance over time, Conway said at a news conference last week. When fewer people have health insurance, hospitals provide more uncompensated care, and then pass the increased costs on to commercial insurance plans, he said.

“There isn’t a corner of our health care ecosystem that’s going to be safe from the disaster that is coming our way,” he said.

“We have one person that told us, ‘We’re not not eating, we’re just not eating meals anymore,'” said Brianne Snow, executive director of the Silverthorne-based . “That is creating a lot of stress on families.”

The lack of food triggers wide-ranging ripple effects. The Summit County resource center has seen its biggest influx of domestic violence survivors in years, Snow said.

“When we talk to these people, it¶¶Ňőap really revolving around huge financial stress, so we’re seeing food insecurity leak out in other ways, as well,” Snow said.

Executives with Colorado food banks and support organizations are sounding the alarm about record-breaking need for food assistance across the state as their organizations contend with federal funding cuts to programs that include the and the , or SNAP.

Chad Molter, executive director of Boulder’s , is also worried about how the lingering government shutdown could surge demand. The pantry is calling for more community donations — both food and monetary — as it tries to stock up.

“I have these dreams of us being in a better place than we are,” Molter said. “I know it takes a lot to move the needle. We’re downstream from a lot of things happening that we can’t control.”

Ellen Ross, director of development and communications for the in Boulder, said the organization is also bracing for more people in the community to need help.

“We’re obviously anticipating an increase if the government shutdown continues (and with the) nature of SNAP cuts,” Ross said.

This spring, the Trump administration cut about $500 million in funding that went toward the Emergency Food Assistance Program, which supplements states’ food bank supplies.

Since those cuts, protein has been hard to come by at the food bank in Routt County, said executive director Sue Fegelein, who joined Summit County’s Snow and other executives in a virtual roundtable Wednesday organized by Colorado Sen. Michael Bennet,

“We have not been able to get the meats we used to get provided through Emergency Food Assistance,” Fegelein said. “In its place, we’ve been getting fish sticks. And not a lot of them.”

Similarly, Bob O’Connor, CEO of the , said his Greeley-based organization is down 900 pounds of food this year compared to 2024, due to the Emergency Food Assistance Program cuts.

The Weld Food Bank serves 1,700 people a day through an emergency food box program and delivers sustenance to 600 homebound seniors every month.

“We’re serving more people in a day than we used to serve in a week, and the amount of food coming in is far less,” O’Connor said. “That means not every day of the week is there meat or other staples. The other thing is, food doesn’t happen in a vacuum. If you’re coming in for food, you’re also struggling to pay utilities and rent, so we’re hopefully keeping people from living in their cars or on the streets.”

O’Connor said the food bank is seeing more clients just above the poverty line who can’t make ends meet.

About 11% of Coloradans lack reliable access to nutritional food, according to the most 

More than 600,000 Coloradans receive SNAP benefits, commonly referred to as food stamps. The federally funded program allows low-income residents across the country to buy food. Bennet said federal support for SNAP continues through the end of this month, but that come November, the program’s future is uncertain.

The massive passed by House Republicans this summer reworked the SNAP program, restricting who can access food resources. Legislators cut about $186 billion from SNAP funding through 2034, according to estimates from the

Food assistance leaders in the state worried about what will happen to Colorado communities already plagued by hunger after the looming federal cuts and restricted access to resources.

“Without food, we will see significant ripple effects with respect to the health of people in our communities,” said Amber Henning, the Western Slope director of development and community relations for the . “The choices they’re making as to whether they seek health care or pay their bills or eat. It¶¶Ňőap important to recognize food is the stone in the water, and the ripples are significant and wide, and we will see a lot of ripple effects. More than we have now.”

Those who want to help can give back in a number of ways, said Nate Springer, president and CEO of the .

They include:

• Donate food or money to a local food bank in your area
• Volunteer your time at a food bank organization
• Organize a food drive at your home, school or church
• Advocate and amplify the message that neighbors in your community are struggling to eat and programs designed to help them are financially hurting

While some may have negative preconceived notions about those who use food banks, Springer emphasized that it’s everyday people in your neighborhood — teachers, active duty military members, construction workers, health care employees, hungry children — who are being served by them.

“Every single person can help their neighbors in multiple ways,” Springer said.

Prairie Mountain Media reporters James Burky and Dana Cadey contributed to this report.

But physical therapist Chris Edmundson said the new law will just aggravate the stress from rising costs that he and other small-business owners have struggled with over the past few years.

Edmundson, who runs eight physical therapy clinics in Colorado and one in Hawaii, called inflation a “national shock to the system.”

“And now this bill. It will put additional pressures on our company,” Edmundson said.

The biggest drawback to Edmundson is the impact on Medicaid and other health care programs. Many of the patients of Integral Physical Therapy are on Medicaid, a joint state-federal program that provides health care for children and people with low incomes and disabilities.

as a result of policy changes to health care programs, including Medicaid. The nonpartisan Congressional Budget Office estimates about 11.8 million American could lose coverage.

Edmundson, who has a doctorate in physical therapy, said he started his company nine years ago with the intention of expanding access for patients covered by Medicaid. “We’ve always prided ourselves on serving that population.”

However, Edmundson expects that the law’s changes in eligibility, more frequent reporting on recipients and work requirements will reduce the Medicaid rolls, leaving people without health care coverage and perhaps decreasing his business.

“People will suffer. That’s the thing that is most troubling,” Edmundson said. “And for us it’s going to lead to less overall patients coming through the door. That will mean there’s a possibility we have to lay people off, possibly providers and support staff.”

Hunter Nelson hears similar concerns from other small-business owners in Colorado. She is the director of the Colorado office of the , a national organization.

“One third of Medicaid enrollees are connected to a small business. It’s going to impact our small-business owners as well as workers, especially in lower-wage sectors,” Nelson said.

by the Small Business Majority and Georgetown University found that 57% of small-business owners oppose cuts to Medicaid while only 23% would support cutbacks.

The legislation signed into law on the Fourth of July also allows for the expiration of enhanced premium tax credits for people who buy health care plans through the Affordable Care Act marketplace. by the Small Business Majority showed that 74% of 504 small businesses surveyed favor extending the credits.

The failure to extend the federal subsidies is expected to drive up premiums on Colorado’s individual health care market by an average of 28% statewide, the Colorado Division of Insurance said. Costs in the western part of the state are projected to jump by over 38% next year.

Last year, about 321,000 people received subsidies for health care insurance on Colorado’s marketplace. The average statewide increase in premiums was 5.6% for 2025, according to the governor’s office.

Nelson said the end of the tax credits means that some Colorado business owners who want to buy health insurance for themselves or their employees won’t be able to. The Small Business Majority and others met with members of Congress while the tax bill was being debated and plan to keep sharing the stories of small business owners.

“We just need to make that message loud and clear. We’re going to see fallout from passage of the bill,” Nelson said.

The fallout could be widespread if Nelson’s fears materialize. said the roughly 715,000 businesses classified as small comprised 99.5% of all Colorado businesses and employed about 1.1 million people.

In contrast to the Small Business Majority, praised the new law, saying that a competitive, pro-growth tax policy “is essential to strengthen the economy and raise wages for workers.”

NFIB, supported the legislation, calling it “one of the most pro-small-business pieces of legislation in recent history.” The law will prevent “a massive tax hike” on more than 33 million business owners and provide a tax cut for most small-business owners, the group said.

One of the victories cited by the NFIB is a provision making a small-business tax deduction permanent. The new law increases the deduction from 20% to 23% for businesses taxed at the individual rather than corporate level.

The Small Business Majority supported by allowing businesses to deduct the first $25,000 in qualified business income from their annual tax obligations. Nelson said 74% of benefits under the current system flow to the wealthiest 5% of the businesses rather than typical Main Street entities.

“It would create more of a bottom-up tax reform structure that would also benefit more of our smaller businesses contributing to and powering our local economies,” Nelson said.

Edmundson said a provision in the tax bill that looks like a positive for his business isn’t all it’s cracked up to be. Under the new law, health care providers are set to get a 2.5% bump in Medicare fees.

“That sounds really great. However, the fee was cut 2.83% in January, so it’s just restoring some of the money they took away,” Edmundson said.

Health care providers have seen cuts in Medicare fees for the last five years, Edmundson said. Medicare is the federal health insurance program for people 65 and older.

Edmundson worries about the effects of new work requirements for Medicaid recipients. Many able-bodied recipients between ages 19 and 64 will have to show they worked, attended school or volunteered for 80 hours per month.

In his practice, Edmundson said therapists work with people who might not qualify as being disabled but have debilitating conditions that make working difficult. He said physical therapy can get people back to work and living their lives without more expensive or intrusive treatments.

“We’re concerned as health care providers that this work requirement is going to preclude some people from completing their rehab,” he said. “Another concern I have is that we have some people — family members, friends of our patients — who stopped working to care for their loved ones and they need to be on Medicaid because of their lack of income.”

New reporting requirements and changes in paperwork will boost the burden on clinic employees, Edmundson added. by making them harder for people to navigate.

“There’s nothing about this bill or this way of thinking that helps the sort of business that I’m in. It certainly doesn’t help patients,” Edmundson said.

The bill, ushered through Congress by Republican leadership and signed by Trump Friday, includes $4.5 trillion in tax cuts, slashes spending on Medicaid, and creates temporary tax deductions for overtime and tipped income. It includes $170 billion for immigrant detention and for new personnel for Immigration and Customs Enforcement.

on receiving Medicaid payments for a year. New parents can set up a new type of children’s savings account. The federal government will dramatically roll back clean energy tax credits — including those that help people buy electric vehicles — while expanding another credit for a certain kind of coal.

The tax breaks will translate to savings for most earners, with the largest benefits skewing toward the wealthiest residents.

The bill makes tax reductions passed during Trump’s first term permanent. But tens of thousands of people are at risk of losing Medicaid and food assistance in the next few years.

How Colorado’s members of Congress voted on the Trump tax bill — and what they’re saying

For Colorado, the bill means drastic changes to state finances that may require lawmakers to return to the Capitol in the coming months to deal with the fallout. State revenue is projected to fall by as much as $800 million by the end of its 2025 fiscal year.

"It¶¶Ňőap going to be really hard," Sen. Judy Amabile, a Boulder Democrat who sits on the legislature's Joint Budget Committee, said of the task facing policymakers. "We are going to have to come together and figure out what (to do). An $800 million cut to our revenue is enormous."

Here's a look at how the tax bill will impact Colorado in different ways.

For taxpayers

The bill institutes a variety of tax cuts. Some are permanent, while others are temporary.

On the permanent side, the bill enshrines current tax rates and brackets that were rejiggered , preventing an increase at year's end when those cuts were set to expire. It includes scores of business-related tax cuts, including allowing businesses to immediately write off 100% of the cost of equipment and research.

As for temporary reductions: The bill creates new tax deductions for tips, overtime and auto loans for the next four years. Workers can deduct up to $25,000 in tipped income on their taxes; up to $12,500 in overtime income; and $10,000 on loan interest for cars assembled in the United States, .

For Colorado state tax purposes, the overtime provision applies only for the current tax year, Gov. Jared Polis' office said. Earlier this year, the legislature to continue taxing that income, should the federal government shift gears, but it takes effect for the 2026 tax year.

The federal bill also creates a temporary $6,000 deduction each year for people 65 and older. That will also expire by tax year 2028.

For families, the bill increases the child tax credit from $2,000 to $2,200 for most taxpayers, and the bill creates a new children’s savings program, called Trump Accounts, with a potential $1,000 deposit from the Treasury.

In Colorado, taxpayers would get total tax cuts of more than $10.5 billion next year, . Those making between $59,700 and $103,000 a year would save about $1,760 in 2026 from the tax provisions of the bill.

, the lowest-earning American households would lose about $885 a year by 2030, largely because of cuts to Medicaid and food assistance. The top 10% of earners are set to receive roughly 80% of the bill's benefits, the school estimated, while noting those earners pay about 70% of federal taxes.

For state revenue

The tax bill doesn't just cut revenue for the federal government. Its passage means less money for the state, too.

For the remainder of this fiscal year, which began July 1, Colorado officials are projecting a loss of between $500 million and $800 million, Polis' office said Tuesday, and hundreds of millions of dollars each year after. Lawmakers already made $1.2 billion in cuts earlier this year to balance the current budget.

The changes to overtime taxation account for as much as $250 million in lost revenue projected this year for state income taxes. The other big slice comes from changes to business tax credits, particularly related to depreciation, Polis' office said.

The bill will also shift new costs onto the state, and those will soon strain the budget from the other direction. The new costs include implementing Medicaid work and eligibility requirements and an increased expense to the state for overseeing food assistance. Those changes go into effect in the coming years -- some of them after the 2026 midterm elections -- so they won't have an immediate impact.

But all told, they'll likely require more than $200 million in new, annual spending from the state.

As for this year, the longer the state waits to sort out this latest financial gap, the governor's office said, the harder it will be to fill. Since Colorado's fiscal year just started, each day means there is less money to cut or room to maneuver to make up for lost revenue.

That, in turn, raises the specter of yet another special legislative session that would be the third in three years, ahead of the next regular convening in January. The governor's office said Polis is still evaluating the bill's impacts.

Amabile said she was bracing for a special session -- and for the "painful" decisions it will bring.

"What scares me is that we are going to have to make some cuts," she said. "And the best way to make the cuts is to come together and decide what is it -- what are our priorities? What are the most important things? And what are the most efficient ways to achieve the things that we all agree need to be protected?

"What I already see happening is silos (of organizations and causes) starting, to want to protect their thing, without any other context."

For Medicaid

The tax bill includes more than $1 trillion in cuts to planned Medicaid spending through 2034 at the national level. Most Medicaid changes won’t take effect for more than a year, but the state may have to increase its spending before then to prepare.

Federal spending on Medicaid in Colorado will likely drop somewhere between $11 billion and $18 billion over 10 years, , formerly known as the Kaiser Family Foundation, which is a nonprofit that studies the health system. The state, which shares Medicaid costs with the federal government, hasn’t yet projected how its own spending will change. In the state's last fiscal year, total spending on Medicaid was about $15 billion, including federal contributions.

In some cases, such as when people no longer qualify for Medicaid, the state will spend less. In others, Colorado will have to decide whether to make up the lost federal dollars or make cuts to either services for recipients -- who include about one in four Coloradans -- or payments to providers.

Starting in January 2027, the state will have to verify that about 377,000 people in the Medicaid expansion population under the Affordable Care Act -- adults earning up to 138% of the poverty line, who don’t qualify for Medicaid for another reason -- either meet new work requirements or qualify for an exemption. That will put significantly more work on the state and on counties.

Many able-bodied recipients between ages 19 and 64 will have to show they worked, attended school or volunteered for 80 hours per month. Colorado will have to build infrastructure for people to report that information and to monitor their compliance.

In addition, recipients will have to go through the full eligibility process twice a year, instead of once. Colorado can complete that process automatically about three-quarters of the time, but when it can’t, recipients will have to fill out a 16-page packet to keep their coverage.

in Colorado would become uninsured if the bill passed, and an additional 40,000 would lose coverage if enhanced ACA subsidies in insurance exchanges expire this year, as scheduled. It made those calculations before the Senate amended the bill, increasing the Medicaid cuts, so the projections are likely higher now.

21,000 undocumented Coloradans could lose Medicaid coverage under Trump tax bill

A clearer loss for the state budget is set to come in 2027. That's when the federal government will start reducing how much states can tax health care providers, such as hospitals. Colorado currently charges the maximum provider tax rate of 6%, but the threshold will drop by 0.5% per year, until it reaches 3.5%.

States use the money they collect from providers to claim federal matching funds, so reducing the tax has wider implications. The Colorado Hospital Association estimated the state could lose about $10 billion over 10 years, leaving less money available to compensate facilities that treat larger numbers of poor patients. The state also uses the money to pay its 10% share of costs to cover the Medicaid expansion population (those earning up to 138% of the poverty line).

For food assistance

The tax bill will slash food assistance -- the Supplemental Nutrition Assistance Program, or SNAP -- by $186 billion through 2034, . That's the biggest cut to the program . It will do that by instituting new work requirements and by shifting new costs onto Colorado and other states.

Roughly 617,000 Coloradans, or more than 10% of the state's population, receive food assistance each month.

The program provides money for low-income people to buy food. In Colorado, a family of four with a maximum income of $62,400 a year qualifies. The benefits can be spent on a variety of foods but not alcohol, hot foods or other household items.

The bill will require the state to pay for more of SNAP's administrative costs -- about $50 million in new spending annually. It will also require Colorado and other states to start paying for some of the program's cost, depending on the scale of each state's error rate. In Colorado, that would mean as much as $140 million a year, according to the state Department of Human Services.

All of that translates to more Coloradans losing food assistance. , 55,000 Coloradans are at risk of losing SNAP benefits because of new work requirements that expand on existing work rules in the program.

For climate and energy

When it comes to the environment and natural resources, the bill rescinds a vast swath of Biden-era investments in clean energy, ends tax credits for consumers who buy climate-friendly products, and undoes regulations and fees on oil and gas production. It also rescinds $267 million in Inflation Reduction Act money that's used to supplement National Park Service staffing.

The cuts reflect stark opposition from the majority of Republicans to many government efforts to address climate change.

The policy package will raise electricity costs for consumers, said Will Toor, the executive director of the Colorado Energy Office in the Polis administration. He called it a “remarkable act of national self-sabotage” that will allow China to lead the sector.

“We're talking about kneecapping advanced industries in the United States,” he said. “It's as if somebody was designing a bill to try to assure that the future belongs to other countries and that the United States will weaken its competitiveness in almost every advanced industry.”

Under the Biden administration’s 2022 Inflation Reduction Act, companies building wind and solar farms could qualify for tax breaks of up to 30% of costs. Those tax breaks now end after 2026 for projects that have not yet begun construction.

Susan Nedell, a senior advocate for the West for -- a nonpartisan group of climate-minded business leaders -- expects the cancellation of big projects in Colorado and nationwide, along with layoffs and fewer investments in solar and wind projects,

The bill also ends a swath of tax credits for consumers:

• Tax deductions for energy-efficient lighting and HVAC systems used in construction, expiring June 30, 2026.
• A tax credit for new homes that meet energy efficiency standards, expiring June 30, 2026.
• A credit for home renovations that improve efficiency, expiring Dec. 31.
• Tax incentives for geothermal heat pumps and other home efficiency products, expiring Dec. 31.

Federal tax credits of up to $7,500 for people buying new electric cars and a $4,000 credit for used cars will now end Sept. 30.

On Dec. 31, a federal tax credit for homeowners of up to 30% of the cost of installing rooftop solar systems will end.

A provision opposed by a broad coalition of Coloradans that would have mandated the sale of public lands was struck from the bill. But other changes remained that make it cheaper for oil and gas companies to use public lands.

The bill undoes the Biden administration’s increase in royalty rates for oil and gas leasing and rescinds mandatory royalty payments on methane produced on public lands by oil and gas companies. It also mandates quarterly lease sales for public lands in the West -- a change that eliminates agency and local discretion on whether land should be leased.

Industry leaders in the West applauded the bill, with Western Energy Alliance president Melissa Simpson saying it will “unleash the energy we need.”

The Associated Press and The New York Times contributed to this story.

, the legislation formerly known as the One Big Beautiful Bill Act, has a provision that would penalize states such as Colorado that use their own funds to cover undocumented people. Colorado covers any undocumented children who sign up for Medicaid, but restricts coverage for adults to pregnant and postpartum women.

The House of Representatives passed the Senate’s version of the bill Thursday, sending it to President Donald Trump, who has made it a core pillar of his second-term agenda.

The bill reduces the federal government’s share of the costs for what’s known as the expansion population — adult citizens who earn up to 138% of the poverty line and don’t qualify for Medicaid because of pregnancy or a disability — from 90% to 80%, forcing states to either .

Colorado could lose about $300 million in federal funding annually if the federal government reduced its share, Gov. Jared Polis said.

The state faces a $700 million budget hole next year and recently announced it would lay off 11 people in the health department if it couldn’t regain a $1.9 million federal grant — meaning it would be fiscally almost impossible to accept a loss of hundreds of millions, even if lawmakers want to continue covering undocumented people.

The about 11.8 million people would lose coverage and the federal government would spend about $1.1 trillion less on health insurance programs if the bill passed in its current form, with the vast majority of cuts coming from Medicaid. At the same time, the bill is projected to by about $3.3 trillion because of tax cuts and increased spending on other priorities.

The Colorado Department of Health Care Policy and Financing reported 21,261 undocumented people had Medicaid coverage as of June 22.

More than three-quarters were children, with the rest qualifying because they were pregnant or in the postpartum period. A department spokesman said they will release the cost of insuring the group in July or August, after compiling numbers from the fiscal year that ended June 30.

The bill in Congress also to purchase health insurance on the federal marketplace.

Federal law prohibits low-income immigrants from enrolling in Medicaid if they’ve lived in the country for less than five years, but has allowed them to qualify for subsidies to buy insurance.

Only permanent residents (those with so-called green cards), certain Cuban and Haitian immigrants, and people from countries in the Compact of Free Association, such as Palau and the Marshall Islands, would qualify.

The Trump administration also announced on June 20 that it would no longer allow undocumented people who .

Connect for Health Colorado estimated that about 6,000 people in the state would likely lose marketplace coverage if the bill passed. They wouldn’t qualify for any programs offering insurance, but could receive some help through a state law requiring hospitals to offer discounted care to people with low incomes, or through limited programs covering services such as family planning, a spokeswoman said.

Three of Colorado’s four Republican members of Congress — Rep. Gabe Evans, Rep. Lauren Boebert and Rep. Jeff Crank — urging the state to end its coverage of undocumented people. Rep. Jeff Hurd, a Republican who represents much of western and southern Colorado, was the exception.

In the letter, they said that covering undocumented people would take benefits from “those who need it most,” especially if the bill in Congress reduces federal payments to the state.

“We stand united in the common cause of protecting Medicaid for generations to come by ensuring only lawful beneficiaries can access this critical program,” the letter said.

Most Medicaid services are mandated by law, meaning the state has no choice but to pay for care that children, pregnant women and other qualifying people need, even if it would prefer to redirect that money. The most significant exception is “waiver” services provided to help people with disabilities stay in their homes.

Raquel Lane-Arellano, communications manager at the Colorado Immigrant Rights Coalition, said taking coverage from immigrants is “short-sighted,” especially since all states have to cover care for undocumented people through

That program pays for labor and delivery, dialysis for people with end-stage kidney disease and emergencies that could kill someone or cause them to lose a limb.

For example, if an undocumented woman with a low income arrived at a hospital in labor, emergency Medicaid would cover the delivery, but not any follow-up care she might need. (The baby would be eligible for full Medicaid coverage, having been born in the United States.)

Covering a delivery, but not the prenatal care needed to give a baby the best chance of being healthy, doesn’t make sense, Lane-Arellano said. Undocumented people do important jobs, which they won’t be able to do if they get sick from lack of care, she said.

“We know that preventive care is the most effective way to cover our communities, and to take that away seems cruel,” she said.

Dr. P.J. Parmar, who runs a at Mango House in Aurora, said he worries less about the state dropping undocumented people from coverage than about overall budget cuts to Medicaid.

Refugees qualify for Medicaid without the five-year waiting period, and relatively few undocumented people have the wherewithal to get through the process of signing up for Medicaid or the individual marketplace, he said.

“Though Colorado tries and gets points for trying, we don’t cover many undocumented people,” he said.

Jim Garcia, CEO of Tepeyac Community Health Center in Denver’s Elyria-Swansea neighborhood, said he doesn’t know how many patients might become uninsured, because they don’t ask about immigration status when providing care.

But any reduction in Medicaid revenue would be a problem, he said. The organization had to lay off medical and dental providers at the end of the COVID-19 public health emergency, when about 537,000 people lost Medicaid coverage. Some have regained it since.

Tepeyac is trying to bring in more patients with private insurance and to attract more philanthropists interested in health care for low-income communities, but Medicaid will remain the centerpiece of its model for the foreseeable future, he said.

“That’s not going to be enough (to avoid cuts) if we’re talking about a major reduction in Medicaid,” he said.

Updated 4 p.m. July 3, 2025: This story has been updated to reflect the passage of the Republican tax and spending bill.

The legislation is now on the precipice of full passage later this week, though one Colorado Republican congressman has already signaled he may not support it. While the massive bill would cut taxes primarily for the wealthy, state officials have also warned that it will slash Medicaid and food assistance, prompting tens of thousands of Coloradans to lose health insurance while further straining the state’s finances, as well as its already struggling rural health system.

“This bill is a massive wealth transfer from the working class to the rich,” U.S. Rep. Jason Crow, a Democrat from Aurora, said on social media. “It would kick millions off their health care, take away food assistance for millions and add trillions to the national debt.”

After a daylong vote-a-rama, Senate Republicans passed Trump’s “One Big Beautiful Bill” Tuesday morning, with Vice President JD Vance arriving to break a 50-50 tie in the chamber and send the bill back to the House.

The proposal includes $4.5 trillion in tax cuts in part by making 2017 reductions permanent, boosting the child tax credit and adding deductions for older Americans. It would balloon federal deficits by nearly $3.3 trillion over the next decade, nonpartisan analysts estimate, while funding Trump’s mass-deportation program, slashing Medicaid by nearly $1 trillion, and rolling back clean energy policies and funding.

Gov. Jared Polis’ office indicated Tuesday that the bill would have substantial financial costs for Colorado. Changes to , or SNAP, would require the state to take on as much as $200 million in new costs. New Medicaid work requirements would cost $57 million to implement, his office said, while Medicaid would lose more and more each year, reaching as much as $550 million by 2030.

Projections from congressional Democrats indicated that six rural hospitals could close in Colorado as a result of the Medicaid cuts and that nearly .

In separate statements Tuesday, U.S. Sen. John Hickenlooper of Colorado called the bill “pure lunacy,” while Sen. Michael Bennet castigated it as “a massive step in the wrong direction.” Colorado’s Democratic House Speaker, Julie McCluskie, said the bill was a “complete betrayal of the American dream” that would “cruelly strip health care from over 100,000 Coloradans and increase costs for working families.”

An estimated Colorado taxpayers would get total tax cuts of more than $10.45 billion next year, with more than 60% of those savings going to people who make $168,400 or more per year.

The bill now heads to the House, where it originated and where Republican leaders have indicated they want to vote on the bill’s passage as soon as Wednesday. The margins in the House are expected to be razor-thin: When the bill initially cleared that chamber, it did so by a 215-214 vote, with only Republicans in support.

‘Significant changes’ needed, Hurd says

And on Tuesday, one of the Colorado Republicans who previously supported the proposal signaled opposition this time around.

“The Big Beautiful Bill sent back to the House from the Senate is going to require significant changes in order to pass,” U.S. Rep. Jeff Hurd, who represents much of the Western Slope, said in a statement to The Denver Post. “I look forward to working with leadership and my colleagues to pass a bill consistent with the promises we made on the campaign trail.”

Asked what changes the congressman wanted, Nick Bayer, Hurd’s chief of staff, said Hurd was “reviewing the proposed changes now.” Hurd previously signed a letter calling for the Senate to abide by the House’s Medicaid cuts, which were smaller but still totaled over $800 billion.

In a statement Tuesday, U.S. Rep. Lauren Boebert’s spokesman, Drew Sexton, said the congresswoman was still reviewing the bill to ensure it “complies with President Trump’s and the 4th District’s priorities” of tax relief, border security, reforms to the Medicaid and food assistance programs, and “getting rid of the Green New Scam.”

Messages sent to Colorado’s other Republican representatives, Jeff Crank and Gabe Evans, were not immediately returned Tuesday. In , Evans described the bill as “a vision that provides real, tangible benefits which make life safer and less expensive, while also being better stewards of taxpayer dollars.”

The , state officials have warned, is extensive cuts to Medicaid and food assistance, which provide health care and nutrition benefits to hundreds of thousands of people across the state. Earlier estimates from the state’s budget office projected the then-current version of the bill could cost Colorado between $900 million and $2.5 billion per year.

“Today, Republicans in the Senate voted to kick Americans off health care, raise costs on insurance, kill jobs, increase our deficit and debt, and make it harder for kids to access food. This shameful vote comes at the expense of hardworking Coloradans,” Polis said in a statement Tuesday.

He, like McCluskie, called on the state’s Republican members of Congress to oppose the proposal.

Gauging impact of Medicaid cuts

KFF, a nonpartisan health care think tank formerly known as the Kaiser Family Foundation, that Colorado would lose roughly $11 billion in federal Medicaid spending over the next decade under the bill. The bill’s changes would strip 155,000 residents of their health coverage by 2034, the organization said.

Of the reductions, $1.5 billion would hit rural Colorado, leading to 23,000 residents losing Medicaid coverage in those areas, .

Those estimates were based on the House version of the bill, which proposed less-severe Medicaid cuts than those adopted by the Senate on Tuesday. Under the Senate version, 11.8 million Americans would lose health care, according to the nonpartisan Congressional Budget Office.

The , which oversees the Medicaid program here, did not yet have fully updated estimates on the impact of the Senate version on the state, a spokesman said Tuesday morning.

“There’s nothing beautiful about this bill,” Lydia McCoy, CEO of the Colorado Center on Law and Policy, an anti-poverty advocacy group, said in a statement. “Medicaid recipients will lose access to the health care that keeps them alive, and hospitals across rural Colorado will close their doors for lack of funding. The cruelty of this legislation is exceeded only by its short-sightedness.”

The listed hospitals are spread across the state, including three on the Western Slope, one in the San Luis Valley and two on the Eastern Plains. The report is based on one version of an evolving bill, so the final result could cause financial distress for fewer, or more, Colorado hospitals than anticipated.

Other types of providers, including community mental health centers and safety net clinics in Colorado, also expect to cut services or close locations, though groups representing the clinics don’t foresee providers going under entirely. The Senate report didn’t examine effects on provider types other than hospitals.

The backed by President Donald Trump, as passed by the House of Representatives, would add work requirements to Medicaid, increase the cost of health insurance on the individual marketplace and penalize states that cover undocumented immigrants, among other provisions.

A proposed amendment would also reduce states’ ability to draw down more federal funds by taxing health care providers, but its chances in the full Senate aren’t clear.

The Congressional Budget Office projected that about 10.9 million people will lose their insurance nationwide because of provisions in the House version of the bill, and an additional 5.1 million would become uninsured if larger subsidies to buy insurance on the individual marketplace expire this year.

The CBO didn’t produce state-by-state estimates, but other groups have projected that as many as could lose Medicaid, and could drop out of the individual health insurance market.

Congressional Republicans said the bill would protect Medicaid for vulnerable populations by removing undocumented immigrants and adults without disabilities who aren’t working.

Colorado hospitals make list

Researchers at the University of North Carolina at Chapel Hill, in a report requested by Senate Democrats, estimated that 338 rural hospitals nationwide , including six facilities in Colorado.

The report included hospitals that have an outsized share of patients covered by Medicaid and those that have lost money three years in a row.

The were:

• Delta Health Hospital in Delta
• San Luis Valley Health Conejos County Hospital in La Jara
• Grand River Health in Rifle
• Prowers Medical Center in Lamar
• Southwest Memorial Hospital in Cortez
• Arkansas Valley Regional Medical Center in La Junta

The list doesn’t include all hospitals that could struggle; Lincoln Health CEO Kevin Stansbury that the hospital in Hugo would have to reduce services or close if significant cuts to Medicaid go through.

Delta Health won’t shut its doors, but it would face major challenges from Medicaid cuts, spokeswoman Darnell Place-Wise said.

If fewer patients have Medicaid coverage, the hospital would lose not only the reimbursement for their care, but also payments from a prescription drug program for hospitals serving low-income patients. When the hospital lost the prescription drug payments in 2024, its budget took a $3.2 million hit, she said.

That followed a difficult year in 2023, when the hospital came close to running out of cash while trying to repay pandemic loans from Medicare.

In addition, Delta Health would likely have to spend more on staff to help patients navigate Medicaid’s paperwork, particularly if they have to prove their eligibility twice a year, Place-Wise said. Seeing Congress consider bills that would hit rural hospitals and their patients in so many ways is “frustrating,” she said.

“We’re not closing, but decisions will have to be made about what are the most important services” if the bill passes, she said.

Konnie Martin, CEO of San Luis Valley Health, said she doesn’t think anyone can truly project which hospitals will take the biggest hits. That will depend on the mix of services they offer and how quickly people in their areas lose coverage, among other factors, she said.

“I think there’s no question that this bill is going to be devastating to rural hospitals if it passes,” she said.

For now, all hospitals can do is make their operations as lean as possible — not that rural health care has much fat to cut, she said — and examine which services are least profitable and most dependent on Medicaid. Typically, behavioral health care and obstetrics lose out in that calculation, though hospitals that already cut them would have to look elsewhere.

“There’s only so much that any health care organization can do if they’re not being paid,” she said.

The other hospitals on the list didn’t respond to The Denver Post’s questions about the bill’s possible effects by press time.

‘Costs don’t go away’

The left-leaning Urban Institute and the Robert Wood Johnson Foundation estimated that Medicaid, private insurance plans and individuals in Colorado would spend about $12.9 billion than they would have if nothing changed. At the same time, the value of uncompensated care provided in the state would increase by $6.1 billion.

Hospitals would receive about $4.6 billion less, and provide about $1.6 billion more in uncompensated care, according to the projections.

Rural hospitals are particularly vulnerable if significant numbers of people covered by Medicaid become uninsured, because they have fewer patients with relatively high-paying commercial insurance to offset any increase in uncompensated care.

About half of rural facilities in the state consistently lose money on operations, which they offset with a hodgepodge of local taxes and other revenue, said Megan Axelrod, senior director of regulatory policy and federal affairs at the Colorado Hospital Association.

The arrangements work, but they’re “fragile,” and couldn’t withstand a major hit to Medicaid payments, she said.

Colorado hasn’t lost a rural hospital in about 40 years, but large-scale Medicaid reductions could be the factor that pushes some beyond their ability to find workarounds, Axelrod said.

“Those (care) costs don’t go away” when patients lose their insurance, she said.

Fewer locations, services

Safety net outpatient clinics also project retrenchment if significant numbers of Coloradans lose Medicaid coverage.

The Colorado Community Health Network estimated that about 133,000 patients of federally qualified health centers, or about one-fifth of those who use the centers, would lose Medicaid coverage if the GOP bill passes.

Most of those patients would become uninsured, and the centers would only collect a small amount from sliding fee scales when they came in for treatment, said Ross Brooks, the group’s president and CEO. The centers could lose as much as $637 million over the next four years, forcing them to lay off staff, close locations or stop offering services that generate the most red ink, he said.

Some centers already had to pull back on their services because patients who lost Medicaid at the end of the COVID-19 public health emergency haven’t managed to reenroll or find other coverage, Brooks said. About 519,000 people lost coverage during the first year after the state no longer continued insuring everyone who had enrolled in Medicaid, though some may have returned to the program since.

“Walking into the summer, we’re already in a pretty negative position,” he said.

Federally qualified health centers have a mission to help anyone who comes through their doors, but to do that, they may have to sacrifice services such as mental health or dental care, Brooks said.

“We can’t take on hundreds of thousands of uninsured patients and survive financially” without major changes, he said.

Behavioral health safety net providers haven’t estimated how many patients might lose coverage, but since about 60% of their revenue comes from Medicaid, any losses would be significant, said Kara Johnson-Hufford, CEO of the Colorado Behavioral Health Council.

They were already struggling in the aftermath of Medicaid unwinding, with some closing clinics or laying off staff, she said.

“There’s no cushion to fall back on,” she said.

Work requirements would be difficult for people with severe mental illnesses to navigate, especially if they have to frequently prove they’re still sick enough to qualify for an exemption, Johnson-Hufford said. Even people who manage to keep their coverage may not be able to get care, because the bill would allow copays of up to $35, she said.

Safety net providers want uninsured people to come in and pay what they can rather than going without health care entirely, Brooks said. People who don’t have insurance die younger than those who do, at least partially because they avoid care until a condition becomes an emergency, he said.

“We’ve made such good progress over the last couple of decades” getting patients into primary care, he said. “This seems like such a backward step.”

The , which passed the House and is currently in the Senate, would require states to pay 75% of the cost to administer the , or SNAP, which offers low-income people a monthly allowance to purchase food.

Currently, the federal government splits the cost evenly with states. If the ratio shifted, Colorado would have to come up with an additional $47 million to fund the workers at county human services departments who determine SNAP eligibility.

The bill, backed by President Donald Trump, would also require states to start paying a share of the food benefits themselves. The state estimates it could have to come up with anywhere from $130 million to $259 million annually to pay its share, depending on the language in the final bill.

Colorado can’t come up with that amount of cash, particularly given the state’s constitutional limits on raising taxes, Polis — a Democrat — and 10 people working in human services and agriculture said in the letter. State lawmakers had to close a $1.2 billion budget hole for the upcoming fiscal year, and warned that Colorado could face an even bigger gap next year, with fewer options to fill it.

“Devoid of purpose, this provision is simply a budget gimmick in Washington, D.C., and a devastating blow to states,” the letter said.

If funding for counties doing the work decreases, mistakes will increase, the letter said. Since the bill includes a provision punishing states with higher error rates with more funding cuts, the damage could spiral, particularly since the bill doesn’t include any time for the states to prepare, the letter said. If that happened, the state’s share of the benefits could rise as high as $324 million.

Colorado previously lost about $13.1 million in funding from the U.S. Department of Agriculture to help schools and food banks purchase locally grown produce. The USDA also reduced emergency food assistance because of concerns that undocumented immigrants benefited from it.

In an average month, 617,000 people in Colorado receive a combined $120 million in food assistance. Typically, about half are children. Recipients can earn up to , or about $62,400 for a family of four.

The OBBBA would cut about $286 billion from food assistance nationwide over 10 years. It would expand work requirements, prevent legal non-permanent residents from receiving assistance and cap assistance with dietary planning.

Currently, have to work 20 hours per week to remain eligible for food assistance. The bill would require people between 55 and 64, and those with children older than 7, to work. People with disabilities would remain exempt.

The state hasn’t said how many people might lose food assistance under the new work requirements, but a left-leaning think tank projected about 131,000 would.

The Congressional Budget Office estimated cuts to food assistance and Medicaid would cost low-income households about $1,600 per year, while tax cuts would net the highest earners about $12,000. Middle-income households would come out ahead by $500 to $1,000.

Rep. Lauren Boebert, who represents the Eastern Plains and voted for the House version of the bill, said the bill “restores integrity” to the food assistance program by requiring adults without young children to work.

“Voting yes on President (Donald) Trump’s One Big Beautiful Bill is a major step towards implementing the America First mandate voters delivered to us last November,” she said in a statement. “This critical legislation makes the Trump tax cuts permanent, unleashes American energy production, invests billions in support of our farmers and ranchers by responsibly reforming SNAP benefits, strengthens Medicaid to focus on American citizens who truly need help and delivers a final net deficit reduction of $1.5 trillion.”

The CBO estimated that the bill would reduce the deficit by $2.8 trillion over 10 years, but would also shrink the economy and raise inflation.

Polis’s letter said the state expects to see an increase in theft and domestic violence as families face more financial challenges, and a loss to businesses as the public has less money to spend on food.

“The food ecosystem in Colorado influences every aspect of the economy. We know that a broad variety of outcomes — healthy development for our children, positive educational outcomes, workforce participation, public safety and economic growth — all begin with access to nutritious food,” the letter said. “An assault on this most critical need is contrary to the core mission of government to serve and work efficiently for all. We implore Congress now not to turn its back on hardworking people.”

Provisions of congressional Republicans’  “One Big Beautiful Bill Act” would add work requirements for some people covered by Medicaid and require them to go through the full process of proving eligibility twice a year instead of once.

The bill, backed by President Donald Trump, also would restrict immigrants’ access to health insurance and raise costs for people who buy their health coverage on the exchange, while extending tax cuts for higher earners and spending more on national defense.

Taken together, the provisions would create hurdles for people who don’t have job-based coverage to find and keep health insurance through Medicaid or the marketplace, even if they are employed or have a disability. While the bill wouldn’t entirely return the U.S. health insurance market to its pre-Affordable Care Act state, it would take away options that helped bring down the uninsured rate, experts said.

The House passed the legislation in late May . The bill’s chances in the Senate aren’t clear; both and centrist Republicans have expressed concerns.

At face value, the work requirements shouldn’t affect Montoya, because she has a disability and has caregiving responsibilities for her mother. But she also knows proving that could be a problem. Even without changes, Montoya said she sometimes struggles to prove her continuing eligibility because her condition causes “brain fog.”

“It’s very stressful to navigate a system that is set up to catch you,” she said.

The between 120,000 and 190,000 people in Colorado could lose their insurance, mostly through falling off the Medicaid rolls, over the next 10 years because of the bill. If pandemic-era increased subsidies for individual coverage expire this year, the number of uninsured people in the state could rise by 140,000 to 240,000.

Colorado produced different estimates, finding as many as 110,000 people could leave the individual marketplace because the bill would make insurance harder to get and more expensive. The state hasn’t estimated how many people could lose Medicaid coverage.

About 1.2 million people in Colorado had Medicaid coverage as of April, and about 296,000 bought insurance on the individual marketplace for the current year.

The that about 10.9 million people nationwide would become uninsured, with about 72% losing Medicaid coverage, and the rest losing insurance they bought through the individual marketplace because of eligibility changes in the budget bill. Another 5.1 million could lose individual coverage .

The bill would require some people between 19 and 64 to work or complete other activities for at least 80 hours each month. States would also have the option to require applicants to show they met it in the months before applying for Medicaid.

If the economy takes a downturn, people may not be able to consistently work 80 hours a month to keep their coverage, said Adam Fox, deputy director of the Colorado Consumer Health Initiative. Theoretically, they could fill in the gaps by volunteering when their hours fall short, but no one knows how the state will track and verify that, he said.

Rachel Sanchez, of Greeley, said she can’t hold down a job while going through her third bout with cancer. Medicaid paid for her care for ovarian and colon cancers, and for follow-up care that helped her recover from the physical damage that treatment inflicted. Now, it covers her medication for leukemia, which costs about $1,500 for a weekly dose.

Sanchez’s two sisters also relied on the program during their cancer care. (The three inherited a genetic mutation that increases their odds of multiple cancers.) Not having to worry about paying for treatment, and eventually for supportive care as they neared the end of their lives, reduced the family’s stress during a terrible time, she said.

Cancer patients “can’t just get up every day and go to work, and then go to treatment, and then go back to work,” she said.

The bill would mandate that states go through the full process of verifying eligibility every six months for people who qualified for Medicaid under the expansion, which raised the threshold for adults to qualify for Medicaid to 138% of the poverty line, or $21,587 for one person.

The process is complicated, said Diana Corona, a Denver resident. Once, she forgot to file some paperwork, and only discovered she and her husband had lost coverage when he got sick.

“It’s back and forth, back and forth” trying to provide the right information, she said.

The intention behind the bill is to add friction to the system of getting and maintaining insurance through Medicaid and the individual marketplace, said Sara Collins, senior scholar at the Commonwealth Fund, which researches health policies.

If it passes, people will lose coverage, either because they don’t understand how to keep it, or in the case of the individual market, because insurance has become too expensive, she said.

“The savings (projected with the bill) really come from people not being able to navigate the system,” she said.

Fox said he thinks the estimates of how many people will lose coverage are low, particularly for states like Colorado, where county human services offices have to handle Medicaid eligibility. Automated systems already check recipients’ income eligibility monthly, so making them fill out paperwork and the counties process it twice a year instead of once just creates more opportunities for people to get lost in the shuffle, he said.

Colorado can renew Medicaid coverage automatically for about three-quarters of people who qualify based on income by using existing databases, said Marivel Klueckman, eligibility division director at the Department of Health Care Policy and Financing. The rest have to fill out the full renewal packet. If they don’t return the paperwork, they lose coverage even if they’d still qualify.

The typically runs about 16 pages, though not all parts apply to every household. It focuses on changes in income and who lives in the home. People who qualify for Medicaid because of a disability have to fill out a , verifying their health status and assets.

If the bill passes, Colorado will have to assess how much the workload will increase for county offices that process the packets, Klueckman said. The state will also need to look for ways to verify how many hours people are working without requiring individuals to report it, she said.

People who lose Medicaid in the future would face more hurdles in buying coverage on the individual marketplace.

The bill would forbid states from allowing low-income people to enroll in the marketplace at any point during the year and would require potential customers to verify more information before they can receive tax credit subsidies, . It also would shorten marketplace enrollment window to 45 days, from 76.

Marketplace plans also will be more expensive in the coming years, assuming the bill becomes law, Fox said. It directly raises the maximum deductible and out-of-pocket limit that plans can set, and paradoxically, would raise the price of bronze and gold plans by lowering the cost of silver plans. (Subsidies rise or fall with the cost of silver plans.)

Combined, the marketplace and Medicaid changes will when the Affordable Care Act passed in 2010, particularly if Congress also allows larger subsidies for the individual market to expire this year, Collins said.

Then, Medicaid covered only adults with the lowest incomes, and the individual marketplace was prohibitively expensive, she said.

“It’s a way of repealing parts of the Affordable Care Act without really saying it,” she said.