All eyes are on the Senate as the reconciliation bill (H.R. 1) has moved from the House and now awaits debate. The Senate has released its version, proposing even more significant and concerning changes to Medicaid. This modified bill deepens the threat to millions of Americans and the healthcare systems that serve them, particularly through expanded work requirements and a drastic reduction in the cap on hospital fees used to fund state Medicaid programs.
For Colorado, projections indicated that over 300,000 residents could become uninsured in the coming decade due to the House bill’s changes to Medicaid and Marketplace coverage (significant changes to premium tax credits) under the House bill. The Senate’s proposal makes this outlook even more dire. Most notably, the Senate bill expands Medicaid work requirements to encompass parents of older children, thereby limiting previously exempt populations. Furthermore, it proposes lowering the ceiling on hospital fees used to fund state Medicaid programs from 6% to 3.5%. This is a critical blow for Colorado, as our state currently assesses hospitals at the maximum allowable 6%, meaning a direct and significant cut to our Medicaid funding. Such widespread coverage loss and funding cuts would force unprecedented budget shortfalls for our state and lead to a dramatic increase in uncompensated care, further straining our healthcare providers.
Against this backdrop of potential coverage losses, CBHC holds significant concerns regarding several key aspects of this legislation. While the Senate’s version maintains some exemptions for individuals with a substance use disorder, a disabling mental disorder, or those participating in a drug or alcohol rehabilitation program, these carve-outs are narrow and administratively burdensome to verify, which could discourage these individuals from seeking or remaining in treatment. More broadly, proposed community engagement and work requirements, more frequent eligibility redeterminations, and the addition of copays for certain low-income enrollees threaten to dramatically increase complexity, create severe barriers to care, and cause widespread coverage loss for eligible Coloradans.
The bill’s restrictions on states’ ability to use provider fees—a critical funding source that brings $5.6 billion in federal funds to Colorado—along with proposed reductions in federal Medicaid allocations (FMAP), would severely curtail the state’s capacity to fund essential services. Colorado simply does not have the financial resources to backfill these massive losses that would result from the reduced hospital provider fee cap. The increase in uninsured that will result from these and other Medicaid changes will be exacerbated by changes affecting Colorado’s health insurance marketplace, Connect for Health Colorado, which will potentially increase the number of uninsured Coloradans by an additional 100,000.
What Happens Next?
With the Senate’s version now public, the Budget Committee will compile the reconciliation text for a full Senate floor vote. The goal for Senate Republicans is a swift passage, potentially before the Fourth of July holiday. This fast-tracked process bypasses the usual 60-vote filibuster, meaning only a simple majority (51 votes) is needed for passage. While no specific timeframe has been announced, Senators will debate the measure for up to 20 hours, followed by a “vote-a-rama” on amendments. If the Senate passes its version, both chambers will need to reconcile any differences before the bill is sent to the President for signature. This means every single Senator’s vote is critical.
This is a pivotal moment for our state’s healthcare. Your continued advocacy is crucial to influence ongoing negotiations in the Senate and highlight the harmful provisions within H.R. 1. The next few weeks are critical for drawing attention to these damaging proposals. Join CBHC in strongly urging Colorado’s federal delegation to oppose this bill and advocate for continued, robust federal investment in Medicaid and behavioral health services. Contact your elected officials today! Tell them to recognize the critical importance of these programs for the health and well-being of Coloradans and to reject any measures that would undermine access to life-saving care.
Read CBHC’s full statement here.
