Editor’s note: This story was updated to correct the makeup of party seats in the U.S. House and Senate.

State leaders and the CEO of a Western Slope-based health care center are urging Colorado’s lawmakers in Washington to reject President Donald Trump’s marquee domestic policy bill, saying it could be particularly devastating to rural resort areas. 

The “One Big Beautiful Bill Act,” which passed the U.S. House last month by a single vote, seeks to deliver much of Trump’s agenda on taxes, health care, energy, immigration and more. 

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Folded into the 1,000-page bill are major changes to Medicaid, including new work requirements and an increase in the frequency at which Medicaid eligibility is re-evaluated. It also reduces federal Medicaid funding for states that cover immigrants who are undocumented and prohibits Medicaid coverage for procedures like gender-affirming care and abortions.

An updated fiscal analysis by the nonpartisan Congressional Budget Office shows that the changes could amount to a nearly $800 billion cut to Medicaid over the next 10 years. Previous estimates put the cuts at just under $700 billion.

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Additionally, the bill allows for the expiration of enhanced tax credits for insurance plans purchased on Affordable Care Act marketplaces, which were passed under former President Joe Biden. It also limits enrollment periods for purchasing marketplace plans. 

The budget office estimates the legislation could lead to an increase of 16 million people without health insurance nationally by 2034. 

Mountain Family Health Centers CEO Dustin Moyer on Monday sent a letter to Sens. Michael Bennet and John Hickenlooper, and Reps. Joe Neguse and Jeff Hurd, saying the bill’s provisions could destabilize health care access across western Colorado. 

“The communities we serve have higher rates of uninsured than most communities in Colorado,” Moyer said in his letter. “(The One Big Beautiful Bill Act) will only put health care coverage further out of reach for communities who have limited coverage options.”

Gov. Jared Polis issued a letter on Tuesday to all eight of Colorado’s federal lawmakers, zeroing in on the bill’s proposed changes to the Affordable Care Act, sometimes called Obamacare. Polis warned that the changes, if enacted, would raise health care costs and lead to a surge in uninsured Coloradans. 

Polis’ letter was supported with statements from Colorado House Speaker Julie McCluskie and Sen. Dylan Roberts, Democrats representing broad swaths of the mountain region. 

“These premium increases and the loss of insurance coverage, on top of the proposed cuts to Medicaid, will be devastating for families and destabilize rural health care systems that cannot absorb the cost of more uninsured patients at their facilities,” McCluskie said. 

Mountain Family: ‘Many will become uninsured’ 

Mountain Family serves around 20,000 patients, offering medical, behavioral, dental, and pharmaceutical care through its eight clinics based in Garfield, Pitkin and Eagle counties. As of 2023, those counties, in addition to Summit and Grand, had the highest rate of insured people in Colorado, according to a report by the Colorado Health Institute.  

Moyer, in his letter to lawmakers, said the primary driver for uninsurance is the area’s high cost of living. Many people’s incomes exceed 138% of the federal poverty line — the threshold for Medicaid eligibility — yet the high cost of health care makes commercial insurance unaffordable. 

For those who are on Medicaid, Moyer said he is particularly concerned about new work requirements, which would be for people aged 19 to 64 but allow exemptions for students and caregivers with dependent children. 

Moyer said while “these policies make sense in theory, in practice they appear to be a solution in search of a problem,” adding that 92% of all Medicaid enrollees are either employed, disabled, a student, or a caregiver. 

“These requirements will require an unprecedented increase in administrative capacity to implement,” Moyer said. “Many will become uninsured because of the new confusing paperwork and added costs, not because they are ineligible.”

He cited a Brookings Institute analysis that anticipates the proposed changes will disproportionately impact service industry workers, a sector Moyer called an “economic driver in the rural/resort communities that we serve.”

Fewer patients on Medicaid could also exacerbate financial pressures on federally qualified health centers, like Mountain Family. These centers, also called community clinics, receive special reimbursements through Medicaid and Medicare and are based in areas that have historically lacked access to health care. The clinics are obligated to serve anyone, regardless of whether they have health insurance. 

“The growing number of uninsured patients we care for has already put our sustainability into serious question,” Moyer said. “If the cuts included in (the One Big Beautiful Bill Act) are passed, we face more layoffs and clinic closures.”

Obamacare changes spark concern for commercial insurance 

Moyer also took aim at proposals in the bill that could chip away at coverage offered through Obamacare marketplaces, which he said “only serve to further restrict access to health care.”

The expiration of Biden-era tax credit enhancements, along with shorter enrollment windows and other changes, could result in as many as 110,000 Coloradans losing insurance, the Colorado Division of Insurance said on Tuesday. 

Coupled with the loss of Medicaid coverage, the bill could lead to 300,000 Coloradans losing health insurance over the next decade, according to an analysis by the Kaiser Family Foundation.

Polis, in his letter to federal lawmakers, said the expiration of enhanced tax credits alone could double insurance premiums for some Coloradans who buy plans through the Obamacare marketplace. In Colorado, the state’s version of the marketplace is called Connect for Health Colorado. 

“No corner of our health care system will be safe from the damage that this bill will inflict,” Polis said, urging Colorado’s Congressional delegation to extend the tax credits either through amendments or standalone legislation. 

Roberts, who represents western Colorado counties in the state Senate, said the state has worked hard to stabilize insurance costs and expand coverage, particularly in high-cost communities. 

“It is hard to overstate the negative impact that losing health insurance affordability tax credits would have on Coloradans, especially those in our rural and mountain communities,” he said. 

Where Colorado’s lawmakers stand

Trump’s mega bill has divided Congress along party lines. All but five House Republicans voted for the measure when it passed the lower chamber in May, including all four from Colorado. 

That includes Hurd, who represents Colorado’s 3rd Congressional District, which spans much of the western and southern parts of the state. Hurd said he opposed cuts to Medicaid services but wanted to find cost savings by eliminating waste, fraud and abuse.

“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,” said Nick Bayer, a spokesperson for Hurd’s office, in a text message statement the day after the bill passed. 

Rep. Joe Neguse, a Democrat whose 2nd Congressional District spans the central and northern mountains, voted against the bill alongside every other House Democrat. In a statement, Neguse called the measure “the largest loss of health care coverage in our nation’s history.”

The bill is now making its way through the Senate, where Republicans hold a 53-47 majority. Colorado’s two senators, Bennet and Hickenlooper, both Democrats, have lambasted the measure and have vowed to oppose it. 

Any changes to the legislation made in the Senate will send the bill back to the House for final passage, meaning Hurd and Neguse will have another chance to vote on the package. 

Republicans maintain a 220-212 majority in the House.