It’s not just Coloradans’ Medicaid coverage on the block; the state’s health insurance marketplace is at stake as the U.S. Senate takes up the House Budget Reconciliation Bill, according to state officials.
If the Republican-controlled Congress lets cuts in a big budget bill take effect, tens of thousands of people who buy insurance through Colorado’s marketplace could lose coverage and premiums for the rest would skyrocket, officials said.
Roughly 112,000 people – 43 percent of those now enrolled via Connect for Health Colorado – could lose health insurance coverage if the measure passes the Senate in its current form.
“It is a very big number,” said CEO Kevin Patterson in an interview with CPR. Altogether proposed chances could result in the loss of $620 million of premium tax credits to Coloradans. The changes would also create a financial strain on already stretched providers, like hospitals, he said.
The exchange was established more than a decade ago with the launch of the Affordable Care Act, also known as Obamacare or ACA.
Polis calls on delegation
Gov. Jared Polis said the changes laid out in the bill threaten to destabilize the individual market. He shared his “deep concerns” over the inaction on tax credits in a letter to Colorado’s congressional delegation.
“Failure of the Republican controlled Congress to extend these ACA tax credits, which have saved Colorado families hundreds of millions in premiums, will throw even more people off of health insurance who rely on reinsurance and marketplace coverage to save money,” Polis said in a press release on Tuesday.
Colorado’s uninsured rate could rise by 2 percent to 3 percent due to policy changes in the bill, according to estimates by the Congressional Budget Office, cited by independent health policy group KFF.
Reinsurance pays a portion of high-cost claims, which allows insurance companies to lower premiums for individual health insurance plans.
“The Senate should take action to extend these critical tax credits for hardworking families and start from scratch on the reconciliation bill,” Polis said.
Evans defends bill
Republicans have described health provisions in the bill as a much-needed remedy to excessively expensive programs enacted by prior Democratic presidents.
“I don't support cuts that harm Colorado providers or patients – I support removing waste and fraud,” Rep. Gabe Evans, said in April, in defending the legislation. The Republican represents the 8th congressional district, a swing seat in northern Colorado.
Obamacare needs reworking to limit fraud, according to House Republicans and some conservative think tanks. The sprawling bill, which tops 1,000 pages and is called the One Big Beautiful Bill Act, would reverse changes they object to made under the Biden administration.
“People need to know their health care is at risk,” said Colorado Insurance Commissioner Michael Conway, in a press release. “The federal government is chopping away the financial assistance that has helped hundreds of thousands of Coloradans afford quality coverage.”
Roughly 80 percent of Coloradans who are enrolled in Colorado’s marketplace qualify for financial assistance. The expiration of the so-called enhanced premium tax credits is expected to double the cost of premiums for those customers.
Patterson, with Connect for Health, said people across the state, especially in rural areas, will feel it.
“We anticipate anybody living in an urban area to see around a 95 percent increase in monthly premiums and those living in rural areas, it's about a 125 percent increase,” Patterson said.
New restrictions against immigrants
The bill also includes other key measures, like new verification requirements and new restrictions against immigrants. Those, according to the exchange, could all lead to additional reductions in tax credits, loss of financial help and the potential loss of coverage for thousands statewide.
Polis said when combined with the “disastrous impacts”of the House-passed reconciliation bill, “the federal government is looking to devastate Colorado’s health insurance market, patients, and the health care system as a whole.”
The cost of health care and insurance is too high and the bill will raise costs on hardworking Coloradans, he said in the letter to the delegation.
Enhanced tax credits have made marketplace coverage more affordable for the 24 million Americans enrolled. It’s also fueled record enrollment with state marketplace programs.
Enrollment in Colorado’s program, Connect for Health, is 282,000, which is about twice the number it had in 2021, according to The Commonwealth Fund. In 2021, a year after the pandemic hit, tax credits were made more generous, which sharply boosted enrollment.
Ripple effect of proposed changes
Among the changes in the bill are a shortened enrollment period, coverage delays and an end to automatic enrollment, according to NPR.
All will play a role in making the marketplaces harder for customers to navigate and for the programs themselves to administer, according to a group of leaders from marketplaces in several states with the State Marketplace Network.
The group spoke to reporters in a call Wednesday. It sent a letter to Senate leadership saying the bill will unnecessarily increase costs and burden privately insured Americans, end flexibility for states and that “Americans of every stripe” depend on private coverage through the marketplaces.
Another challenge: Marketplaces will have to adjust to whatever changes will come by the time open enrollment starts in November.
We're talking about a very shortened time timeline,” said Patterson, who joined the call. Plus, “nobody's giving us any extra money.”
Directors of other marketplaces said the changes being considered would shake the health system, including communities, business owners, many kinds of workers, farmers and more.
“It's our hospital systems, our providers, the economy. I mean, it's everything. The ripple effect is just enormous by taking health coverage away from people that want to purchase it,” said Michele Eberle, executive director of the Maryland Health Benefit Exchange, in another call with reporters organized by KFF. “It's going to have a huge ripple effect in our state for sure.”
