By Ali Rakestraw

I’m a family physician and lifelong Coloradan, and I’m watching a health care crisis unfold in real time. Every day, I see patients struggling to afford the care they desperately need — and it’s about to get much worse. The federal government has slashed Medicaid funding, let Affordable-Care-Act enhanced subsidies expire, and is even trying to block Colorado’s law that prevents medical debt from affecting Coloradan’s credit scores. For hundreds of thousands of Coloradans, this means health insurance premiums are about to double or triple, putting basic care out of reach. As a primary care physician, I regularly witness the life-altering and life-threatening consequences that delayed care due to fear of financial hardships can cause. Needing health care is one of the great equalizers that will eventually affect every one of us. As Washington abandons its responsibility to American families, we Coloradans must act to shield our families, neighbors and ourselves from these devastating cuts.

I have been proud that my home state has been a national leader in passing policies that better protect people from the devastating financial consequences that can come with getting health care in the U.S. During the last five years, our state has passed major laws to strengthen those protections: removing medical bills from credit reports (HB23-1126), limiting how much interest can be charged on medical debt (SB23-093), and making sure people taken to court over medical bills can clearly see who is suing them (HB24-1380). These changes mean a medical emergency doesn’t follow someone for years, standing in the way of renting an apartment or getting a small business loan. It means high interest on medical bills doesn’t force families to choose between paying off a growing debt and covering basics like groceries or childcare. These laws have made a real difference for families across Colorado — but with major federal cuts and a high cost of living, the scale of the threat demands we go further.

The stakes are clear. A recent study found more than one in three adults have delayed care out of fear of financial ruin due to unknown prices, and that medical debt is responsible for nearly 60% of bankruptcies. Here in Colorado, medical debt can lead to wage garnishments, home liens and devastating financial hardship, often for modest bills that stem from emergencies or billing errors. Recent cuts to Medicaid are expected to leave 65,000 to 100,000 Coloradans without health insurance in 2026, forcing even more people into impossible choices between receiving lifesaving care and paying rent or feeding their families.

I provide care in Denver, Longmont and various rural communities in Colorado. Well over 50% of my visits include an in-depth discussion about possible cost of treatment or workup, and patients routinely have to forgo valuable medication or testing due to a well-founded fear of financial debt that can be devastating. This year, I was working in a rural emergency room and diagnosed a 56-year-old patient with a heart attack and COPD flare. She needed to be transferred to a bigger hospital, and I pleaded with her for two hours to let me transfer her while she cried about being “better off dead than putting (her) family into debt”. Her husband finally convinced her to get care, but I still wonder about the effect that decision has had on her. And the sad truth is I see versions of her story reflected in other patients’ and friends’ regularly. We should not be forced to a place where dying is a better option than living with the consequences of indebtedness.

Colorado lawmakers are facing a budget crisis that will force painful cuts to programs families rely on. But that makes it even more important to use every tool still available to protect people from preventable harm. Even when dollars are limited, legislation can still shield Coloradans from crushing medical debt, confusing billing systems and unnecessary financial stress. Getting medical care should not push a family closer to losing their home or falling behind on basic needs. As tough budget decisions lie ahead, Colorado must stay committed to using smart, people-centered policies to protect families’ stability, dignity and chance to get ahead.

Alexandra Rakestraw is a family medicine physician who grew up in Longmont and currently practices in the Denver metro area as well as rural Colorado. She is interested in the intersection of health care politics and their tangible impact on health care access and outcomes, especially within marginalized patient populations.