Colorado health care advocates are warning of dire outcomes for rural care providers and patient services under a major domestic policy bill advancing in Congress.

House Republicans in the early hours of Thursday approved the package, which President Donald Trump has dubbed his “big, beautiful bill” that includes a suite of tax cuts, reductions to safety net services and heightened immigration enforcement and defense spending.

It now heads to the Senate for further consideration.

Among the bill’s most sweeping provisions are changes to Medicaid. The bill overhauls the government-subsidized health care program in several ways, including adding new work requirements, redetermining eligibility more frequently and restricting care for certain procedures and undocumented immigrants.

The changes amount to a nearly $700 billion cut to Medicaid over the next 10 years, according to a fiscal analysis by the nonpartisan Congressional Budget Office.

Rep. Jeff Hurd, a Grand Junction Republican who voted for the bill, defended the measure as a way to make Medicaid more efficient.

Hurd represents the 3rd Congressional District, which includes the vast majority of western and southern Colorado and has the highest rate of Medicaid enrollment of any congressional district in the state at 31%.

As Republicans were crafting the measure, Hurd signed onto a letter in April urging House leadership to “preserve Medicaid” by finding cost savings through “​​deregulation, streamlining federal programs, and cutting administrative red tape.”

“He has lived up to that promise, and has voted to help save Medicaid by tightening work requirements, removing illegals, and requiring states to eliminate the fraud in their administering of the program,” Nick Bayer, a spokesperson for Hurd’s office, said in a text message statement.

Colorado health care leaders, however, say the provisions will result in fewer insured patients seeking care.

“It will be absolutely devastating for providers,” said Adam Fox, deputy director for the Colorado Consumer Health Initiative. “We will see providers, clinics (and) hospitals reduce services or potentially close their doors altogether.”

Increased pressure on safety net clinics

Federally qualified health centers, commonly referred to as community clinics, could be among the hardest hit by the federal changes. These clinics are situated in areas that have historically lacked access to care, with several dotted across Colorado’s Western Slope.

The clinics are obligated to serve patients regardless of whether they have insurance. Mountain communities have the highest rate of uninsured residents in the state, according to the Colorado Health Institute.

“In too many of our communities, coverage is already far out of reach due to the high cost of living (and) high cost of health care,” said Dustin Moyer, CEO for Mountain Family, a federally qualified health center that operates clinics in Eagle, Pitkin and Garfield counties.

“I can’t help but think that provisions contained in (House Republicans’) legislation are just going to put health care coverage further out of reach,” Moyer said.

Community clinics have already seen the impacts of patients losing Medicaid coverage.

Congress in 2023 ended automatic renewal for Medicaid, part of its response to the COVID-19 pandemic, in what was known as “Medicaid Unwind.” It resulted in more than 575,000 Coloradans losing health insurance. Nearly a quarter of Colorado residents are covered under Medicaid.

It meant community clinics experienced a double whammy of still having to service those patients without reimbursements from Medicaid.

Moyer said around 2,000 Mountain Family patients were kicked off Medicaid, which makes up roughly 30% of the health center’s budget. That resulted in $1.5 million in lost revenue that forced layoffs, freezes to salary increases, and the closure of two school-based clinics.

Mountain Family served around 17,000 people in the past year.

Further reductions in Medicaid coverage are expected if the work requirements in House Republicans’ bill ultimately become law. The measure would require people aged 19 to 64 who are seeking health coverage in states with Medicaid expansion, such as Colorado, to prove they are working or attending school starting at the end of 2026. It allows exemptions for people with dependent children.

More than 90% of Medicaid recipients already work, according to an analysis by the Kaiser Family Foundation. But the administrative burdens associated with people proving they meet the new work requirements could result in many forgoing coverage.

“Any time you have increased paperwork, people are going to fall off,” said Rich Cimino, executive director for Peak Health Alliance, a nonprofit that negotiates lower insurance rates on the Western Slope.

“People aren’t going to get their letters in the mail on time, the county human service departments are going to have massive increased paperwork to deal with,” Cimino said. “They’re going to be overworked and understaffed and be actively kicking people off Medicaid because of these new requirements.”

Moyer believes around 1,000 Mountain Family patients could be at risk of losing coverage at some point, while an analysis by the Urban Institute, a think tank center, projects that between 113,000 and 128,000 adults in Colorado could lose Medicaid as a result of work provisions.

‘Impossible decisions’

Those projections don’t include the impacts of some of Republicans’ other Medicaid changes.

The domestic policy bill calls for states to review eligibility every six months as opposed to once a year. It also reduces the federal share of funding for Medicaid expansion states from 90% to 80% for states that cover immigrants who are undocumented. Additionally, the bill prohibits Medicaid coverage for procedures like gender-affirming care and abortions.

Those provisions could jeopardize Medicaid funding for Colorado, which is already experiencing budget pressures as a result of its own Medicaid spending. State leaders, who’ve signaled they may need to hold a special session later this year to deal with the cuts, have lamented that they’ll be hard-pressed to make up for any loss in funding.

Moyer said he has “profound concern” for what comes next for Mountain Family and other community health centers if Republicans’ plan moves forward.

“We’re going to have impossible decisions to make about the clinics that we’re able to continue operating, the services that we’re going to be able to provide and who we’re going to be able to serve,” he said.

For some patients in rural Colorado, those health centers are their only care option for a host of services. Northwest Colorado Health, for example, serves around a third of the Yampa Valley region’s population and offers primary, behavioral and dental care in addition to in-home care, hospice, assisted and senior living and school-based services.

“We are the trusted resource for so many marginalized populations. We are the trusted resource for people who are low-income,” CEO Stephanie Einfeld said in a March interview. “For a lot of the services we provide, we’re the only ones who will accept Medicaid and (the) uninsured.”

Bayer, the spokesperson for Hurd’s office, said the congressman “has continuously engaged with constituents and health care providers, hosting numerous meetings and open calls.” He said Hurd “believes Medicaid should be focused on its core mission — serving vulnerable populations like children, seniors, pregnant women, and individuals with disabilities.”

Bayer added that Hurd “supports the rule of law and believes states should not expect federal Medicaid dollars to subsidize programs that conflict with federal policy.

“If states choose to fund those services with their own resources, that’s their decision — but federal taxpayers should not be on the hook,” he said.

Colorado Democrats at the state and federal level ridiculed the bill, which passed by a single vote.

Rep. Joe Neguse, a Boulder County Democrat whose 2nd Congressional District spans the central and northern mountains, stated in a press release that the measure represents “the largest loss of health care coverage in our nation’s history.”

“Our rural and mountain community hospitals and service providers will be among the hardest hit,” Neguse said. “As this disastrous proposal heads to the Senate, I will continue to use every tool available to speak up for families on the Western Slope and oppose this reckless legislation.”

Published on VailDaily.com.