Congressional Republicans want to cut taxes in a big way. As part of a budget blueprint they aim to slash spending, add funding for border enforcement and defense, and make up to $4.5 trillion in tax cuts. One major program that could be chopped back — Medicaid.
What’s it mean for Colorado? It means potentially sweeping changes for Coloradans, especially those enrolled in the program, for health care institutions like community health centers, clinics, and hospitals, and the state’s economy.
To start, what is the Medicaid program?
Medicaid is a $880 billion-a-year state-federal program. It's a bedrock of America’s healthcare system, offering health coverage to millions, a broad variety of people. That includes seniors, people with disabilities, low-income Americans, pregnant women, adults, and children.
Colorado’s Medicaid program is called Health First Colorado. About 1.2 million people, about a quarter of the state’s population, rely on it for everything from doctor checkups to preventative care to ER visits, according to the latest data from the agency.
What do Republicans and the Trump administration say about wanting to cut Medicaid?
Medicaid has long drawn criticism from some conservatives and Republicans. They see the program as inefficient, expensive and too big.
Some have talked about making reforms to Medicaid. Those include work requirements, requiring those receiving benefits from the program to prove that they’re working.
Other proposals could include capping spending per enrollee, limiting the minimum rate at which the federal government matches state funds to the program, restricting the use by states of taxes on providers to finance their share of Medicaid funding and eliminating some Medicaid regulations.
This is all coming to a head in Congress?
Exactly, Congress has started work on the federal budget.
Earlier this month, President Donald Trump said in an interview with billionaire advisor Elon Musk he would not touch Medicaid. But Trump has backed the budget plan and Republicans in the House have given it initial approval. Speaker Mike Johnson detailed what he sees as the program’s problems.
“Medicaid is hugely problematic because it has a lot of fraud, waste, and abuse,” Johnson said. “Everybody knows that. We all know it intuitively.”
He said experts estimate there’s $50 billion in fraud in Medicaid alone.
The agency that runs Medicaid, the Center for Medicaid and Medicare Services, examines payment error rates on improper payments. Most, it found, come from paperwork issues, like missing or insufficient documentation. A report from the agency put that number at a small portion of the total, around 3 percent last year.
What could Medicaid cuts mean for Colorado?
To answer that, let’s go back to 2014. That’s when the Affordable Care Act, or Obamacare, launched. At the time, Colorado expanded who is eligible for Medicaid coverage; that expansion covered many Coloradans who were previously uninsured. With the historic change, there were more Coloradans who had health insurance than ever, and the state’s uninsured rate was cut sharply from about nearly 16 percent in 2011 to below 5 percent in 2023, according to the Colorado Health Institute.
But if Congress cuts funding the state will lose more than $1 billion in federal money to cover those Coloradans. It would be one of hardest hit states, according to a report from the Robert Wood Johnson Foundation, which is a philanthropic group focusing on health.
State leaders would need to cut spending elsewhere to cover the cost. Or they would have to remove hundreds of thousands of people from Medicaid. The group estimates Colorado would have to increase its Medicaid spending by 31 percent to make up for those proposed cuts.
“That's obviously a pretty major hit,” said senior policy advisor Kathy Hempstead, with the Robert Wood Johnson Foundation, noting Colorado would have to come up with a billion dollars or drop people’s Medicaid coverage. “If Colorado were to drop their expansion population, that would also be a really large bump in your uninsured rate,” she said. “The estimate is about 230,000 additional people would become uninsured, which would be a 50 percent increase in your uninsured rate.”
She says either scenario is extremely adverse to Colorado and bad for every state.
Does the state of Colorado have the money to cover the loss of that huge sum of federal dollars?
No way. Colorado is facing its own billion dollar deficit, so it’s already looking at broad cuts. So there’s no way of replacing hundreds of millions in federal Medicaid funding. Colorado House Speaker Julie McCluskie recently told reporters no matter how much lawmakers value things like public schools and higher education, “health care services, Medicaid, all of the safety net programs and services for our most vulnerable in this state, we are just grappling with some pretty difficult choices and cuts.”
So, back to the federal budget, the key political leaders are members of Colorado’s Congressional delegation?
The action so far has been in the U.S. House. Colorado’s delegation has four members from each party. All Republicans voted for the budget resolution; Democrats in the state’s delegation voted against it. Two Republicans, Gabe Evans, of the 8th District and Jeff Hurd, of the 3rd are considered among the most vulnerable on this issue because they have a lot of constituents, more than a quarter of all residents, getting health care due to Medicaid, and they reside in swing districts.
Would their districts be hit hard?
Hurd's district is on the Western Slope and in southern Colorado. Evans' is along the northern Front Range and Weld County.
Both districts would lose more than $2 billion in funding in the coming years, according to one analysis, from the Center for American Progress, a liberal public policy think tank. For Hurd, nearly 60,000 residents of his district would lose coverage; for Evans’ district the figure is more than 40,0000. That’s if the cuts go through.
According to a Congressional District Health Dashboard from NYU Langone Health, almost 30 percent of the residents in Hurd's district are enrolled in Medicaid. That’s the most of any congressional district in the state.
In Evans' district the figure is 25 percent of the population.
What are Colorado Republicans saying about Medicaid cuts?
Hurd, in a press release, called the budget resolution which passed, “a win for America,” saying that a united Republican party delivered on its campaign promises, it doesn’t require specific cuts and is merely a first step.
In an interview with Colorado Matters, he told host Ryan Warner, he believed it was important to “preserve Medicaid benefits for Coloradans,” particularly in his district, while making the program more efficient over time.
“If we're looking at efficiencies, we're not talking about realizing any efficiencies over the course of one year,” Hurd said. “They would be spread out over the course of 10 years and making sure, again, that we are delivering benefits to people who need them. Absolutely a priority for me.”
Evans is pushing back on critics. He posted on X that the Republicans’ bill is not a tax break for billionaires or large corporations, which is how Democrats have described it. He said Colorado is responsible for administering the program, but “unfortunately, we've seen where Colorado's priorities lie. They're spending tens of millions of dollars funding healthcare for illegal immigrants. Instead of cutting fraud, waste and abuse.
A spokesman for the state’s Medicaid program, Marc Williams, said in Colorado, children and pregnant women are the only undocumented people who receive Medicaid. The idea is to get them preventive care, so they don’t need costlier emergency coverage down the road.
He said 14,114 women and children are enrolled in a program called Cover All Coloradans, which launched in January. Lawmakers in 2022 passed HB22-1289, which allows undocumented pregnant women and children health coverage assuming they meet all other eligibility criteria except for citizenship.
“These folks are going to need health care services with or without health coverage and calls to mind the old adage of ‘an ounce of prevention is worth a pound of care.’ ” said Williams via email. “CAC provides prenatal health services so mom has a better chance of delivering a healthy, less expensive baby — along with well-child care to help keep the baby healthy.”
A spokesperson for the governor’s office responded to Evans with even stronger language.
“The reality is the Congressman just voted to pull the rug out from under 163,002 of hardworking Coloradans in his district who receive health care through Medicaid, which will raise costs, and hurt Colorado families and children who will lose care if these cuts go through. His vote will have devastating consequences for his constituents,” she said via email.
In an earlier press release, Democratic Gov. Jared Polis said he urged members of Congress to reject what he called “harmful cuts to Medicaid.” He said they’re “cruel…don’t make sense, and would harm Coloradans and children.”
Democrats are pretty much united against this budget, and the Medicaid cuts?
They’ve said government programs like Medicaid can be made more efficient, but these cutbacks would go down to the bone. Rep. Diana DeGette of Denver. She said traditionally Medicaid was for poor people, seniors who needed long-term care and maybe some children. But as it's grown it touches more people, so deep cuts would be devastating. “It is the shredding of the social safety net,” she said at a news event earlier this month. “Now, a huge percentage of Americans use some form of Medicaid to help pay for their health care costs.”
What do Medicaid patients say about it?
They’re extremely worried and not sure how they’ll manage without this health care. Veronica Montoya is a Medicaid recipient in Denver. She’s a licensed real estate broker, whose career has been severely hit by a series of autoimmune problems, combined with other conditions like diabetes.
“I need help. I need taxpayer help. And it's very humbling,” she said. “Medicaid is hugely important for so many people. And I am just an example of somebody who can go from making six figures to making nothing. And I need help because of the health issues.”
“It's been lifesaving to me,” said Jean Sisneros of Lakewood, a grandma, sixth-generation Coloradan and a diabetic, who has gotten health care through Medicaid.
“I've seen family members of mine die from complications of organ failure due to diabetes.”
She said deep cuts would have an impact on many Coloradans. “If it wasn't for Medicaid, a lot of these people, they wouldn't be getting any health care. It's not fair.”
Do a lot of hospitals and community health centers and clinics rely on Medicaid funding?
Absolutely. Reimbursements from the government covers the care of Medicaid patients they treat, and that helps many health institutions pay the bills.
For example, the Colorado Community Health Network represents 20 community health centers and operates nearly 250 clinics. Those centers provide primary care to one in seven people in the state, about 857,000 people, in rural, urban and frontier areas. About half their patients are enrolled in Medicaid.
So cuts to the program would mean cuts to the delivery of health care statewide. These health services that rely on Medicaid funding run on thin margins. If deep cuts go through, it could mean layoffs, service cuts or worse.
“When hospitals and health centers are forced to close, there goes businesses right behind them because people can't afford to live in a community that doesn't have a doctor, that doesn't have a hospital or an emergency room,” said Polly Anderson, the group’s vice president of strategy and financing. “And so the ripple effects of these kind of cuts are really unending.”’
A list of hospital systems in Colorado shows most get at least 20 percent of their revenue from Medicaid.
At Denver Health, major cuts could cost close to $1 billion out of its $1.5 billion budget, according to CEO Donna Lynne. “We'd have to cut services, we'd have to lay off employees,” Lynne said. “The impact, not just in Denver, but in the entire state, is catastrophic.”
What impact would it have on Colorado’s health system if many people lost Medicaid coverage?
Many would forgo or delay getting health care, which would lead to many later seeking care at hospital emergency rooms, where they can’t be turned away. Emergency care is much more expensive than preventative or primary care.
The Colorado Health Institute found that about half of uninsured people skipped care because of cost, compared to a bit less than one in five people on Medicaid who said that they skipped care due to cost, said the group’s president and CEO Sara Schmitt.
According to data from 2023, only about 40 percent of Colorado uninsured people had a medical visit in the past year, compared with nearly 90 percent of those who are insured.
It also creates challenges for medical providers.
“Are they going to just stop seeing this person who they have a longstanding relationship with because that person no longer has coverage?” said Schmitt. “Can they afford to keep seeing uninsured patients?”
We know there is a political divide, but how does the rest of the U.S. feel about Medicaid? Is it popular?
Yes, according to recent national polling.
Two thirds of adults in the U.S. say they have a connection to the Medicaid program, through health insurance, pregnancy-related care, home health care or nursing home care, coverage for a child or to help pay for Medicare premiums. That’s according to a poll from KFF, an independent source for health policy research, polling and news.
Large majorities of Americans view it favorably, including 64 percent of Republicans, 81 percent of independents and 88 percent of Democrats, according to the poll.
Most Americans think Medicaid works well for lower-income people, though there is a partisan divide over whether Americans see it mostly as health insurance or a government welfare program. Most Democrats and independents say it is mostly a health insurance program, a small majority of Republicans view it primarily as a welfare program, the poll found.
What happens next, now that House Republicans have passed the initial budget?
It’ll all depend on what the Senate does, and then leaders from both chambers would hash out differences, through the budget resolution process. That is far from over, but Medicaid cuts are definitely closer to reality after the recent House vote.
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