What Republicans’ ‘big, beautiful bill’ could mean for Coloradans’ health insurance costs — especially in mountain towns 

Coloradans, particularly in high-cost mountain towns, could face surging health insurance premiums under Congressional Republicans’ tax and spending plan, health care advocates say. 

The sprawling package, which President Donald Trump has named his “big, beautiful bill,” aims to deliver much of the president’s domestic policy agenda, touching on everything from taxes and energy to immigration and health care. 

Among its provisions are nearly $700 billion in Medicaid cuts and changes to the Affordable Care Act marketplace, sometimes called Obamacare. 

The bill places new work requirements on Medicaid recipients, increases the frequency for renewals and reduces federal Medicaid funding for states that use the public health plan to cover immigrants who don’t have lawful status. 

It also declines to extend $64 billion in increased subsidies for insurance plans purchased on the Affordable Care Act marketplace, which are set to expire at the end of this year. The bill also restricts eligibility for Affordable Care Act tax credits and limits enrollment periods. 

Taken together, the reductions in health care spending could increase the uninsured population, which, in turn, could raise commercial insurance costs. Mountain communities already have the highest rate of uninsured residents in the state, according to the Colorado Health Institute. 

“It’s going to make premiums more expensive when they are already more expensive in western and rural Colorado,” said Adam Fox, deputy director for the Colorado Consumer Health Initiative. 

“The providers, the hospitals, the clinics in rural areas are also going to be hardest hit by these cuts,” Fox said. “That affects everyone in the community. It doesn’t matter if they have Medicaid or commercial insurance. … Everybody will be harmed.”

Affordable Care Act changes could exacerbate uninsured population 

An analysis by the Urban Institute, an economic think tank, estimates that between 113,000 and 128,000 adults in Colorado could lose Medicaid as a result of new work requirements. 

A separate study by the Kaiser Family Foundation projects that enrollment through the Affordable Care Act could drop by a third, with roughly 8 million of the 24 million Americans who are insured losing coverage as a result of the Republicans’ bill. 

One of the main reasons is that the bill does not renew enhanced Affordable Care Act subsidies passed in 2022 under former President Joe Biden. Those subsidies extended premium tax credits for three years and expanded eligibility for those making above 400% of the federal poverty line. 

A Kaiser Family Foundation analysis found the subsidies drove record enrollment on the Affordable Care Act marketplace and cut insurance premiums by an estimated 44%, or about $705 annually, for those receiving the premium tax credit. 

With the subsidies set to expire at the end of this year, individuals and families making over 400% of the federal poverty line could see their premiums double. 

In Colorado, that would hit individuals making more than $62,600 per year, according to calculations based on data from the Colorado Department of Local Affairs. For a family of four, it would affect those making more than $128,600.

Health care advocates say it could result in fewer people being able to afford their health insurance. That could exacerbate financial pressures on hospitals, especially in rural areas, 70% of which operate on unsustainable margins, according to the Colorado Hospital Association. 

“If we see a huge increase in uninsured (people), that is going to have a big impact on the providers — not just because they’re having to provide more uncompensated care, but you’re also going to see a huge increase at the community level of people delaying care,” Fox said. 

Rich Cimino, executive director for Peak Health Alliance, a nonprofit that negotiates lower-cost insurance plans on the Western Slope, worries that it could undo years of progress to cut health care costs. 

Launched in Summit County in 2019, Peak Health works to reduce insurance premiums for mountain town residents, who’ve long been paying some of the highest premiums in the country, by negotiating with hospitals and insurance carriers. 

Currently, Peak Health partners with Denver Health Medical Plans to offer insurance options in nine Western Slope counties. A new study out of Johns Hopkins University found the plans reduced health insurance premiums by as much as 17% for participating counties between 2017 and 2021. 

“The heart of what Peak accomplishes starts with hospitals leaning in to help their communities,” Cimino said. “They do lower their rates with us, and we try to drive more business their way — we have more people insured that weren’t before.” 

He said the impact of Republicans’ bill “is really going to clobber that model.”

“The ability for hospitals to lean in to help their communities will be greatly reduced,” he said. “I think it’s going to be most painful for rural Colorado, more than urban.” 
The “One Big Beautiful Bill Act” passed the U.S. House on May 22 and now heads to the Senate for further consideration. Republicans hold narrow majorities in both chambers.