As the first anniversary of H.R. 1 approaches, Colorado Democrats and hospital executives say the law’s Medicaid reductions and eligibility rules are accelerating financial stress in a system where many facilities were already operating on the brink.

Signed by President Trump on July 4 last year, H.R. 1, which the president has nicknamed the “one big beautiful bill,” includes a $1 trillion cut to Medicaid funding over the course of 10 years, establishes work requirements for certain Medicaid recipients, requires biannual eligibility checks for Medicaid recipients, and excludes certain reproductive health care providers from receiving federal Medicaid payments, among other provisions.

Republicans argued the bill would reduce federal spending, increase accountability from the states and Medicaid recipients, and eliminate “waste, fraud, and abuse” from the Medicaid system.

Rep. Brett Guthrie, R-Ken., who chairs the House Committee on Energy and Commerce, said the bill was necessary to “rein in spending,” prevent fraud, and “protect Medicaid’s long-term viability and ensure resources reach the most vulnerable populations.”

Democrats have widely criticized the bill, arguing it will leave millions of Americans without health care coverage.

About 240,000 Coloradans are expected to lose their health care coverage in the next decade as a result of H.R. 1, U.S. Sen. John Hickenlooper said during Thursday’s call.

“By any measure, this is cruelty,” he said. “This is an unforced calamity that the White House really premeditated and put into effect by passing that ridiculous bill.”

U.S. Rep. Brittany Pettersen noted that individuals who lose their health care coverage will delay medical visits until it’s an emergency, which could overwhelm emergency departments and ultimately pass on costs to patients with commercial insurance.

Colorado’s rural hospitals are already in dire straits, with many forced to eliminate certain programs or close their doors entirely due to rising costs, shrinking reimbursements, and state and federal regulations.

Many of these hospitals and care facilities have been struggling for many years, well before the federal budget was passed last year. To avoid closing, many have resorted to eliminating departments and specialty services.

“We’ve already seen maternity wards being closed across Colorado; we are seeing rural hospitals at the brink of whether or not they’re going to be able to keep their doors open,” said Pettersen.

In 2024, nearly 70% of Colorado’s hospitals reported operating with “unsustainable” margins, with expenses far outpacing revenue, according to the Colorado Hospital Association.

One of those rural hospitals is Lincoln Health Community Hospital in Hugo, on the Eastern Plains. According to the hospital’s CEO Kevin Stansbury, the funding from the Rural Health Transformation Program established in H.R. 1 won’t be enough to offset his hospital’s losses in Medicaid reimbursements.

“There’s $50 billion in the fund, and it does not replace the $150 billion in estimated losses for rural hospitals across the country,” he said.

Stansbury echoed Pettersen’s sentiment about the “trickle-down” effect Medicaid cuts will have on all Colorado patients and added that it will have a significant impact on rural economies as well; Lincoln Health is the largest employer in Hugo and the second-largest employer in Lincoln County, he said.

Urban hospitals, particularly “safety net providers” like Denver Health that serve vulnerable populations, are also feeling the squeeze, said Donna Lynne, the hospital’s CEO.

Nearly half of Denver Health’s patients are on Medicaid, and the hospital has had to hire 15 additional employees just to handle the additional administrative requirements from H.R. 1, Lynne said.

“That’s money that’s absolutely wasted, although we’re going to spend it wisely, and we have gotten some support from the state, but multiply the work that we do times all the counties and all the states,” she said. “We’re spending hundreds of millions of dollars implementing just the first phase of this law.”

While government-funded programs such as Medicaid and Medicare account for over 60% of hospital coverage, the Colorado Hospital Association said, reimbursement falls billions of dollars short of actual care costs.

H.R.1 will only make a bad situation worse in 2027, according to CHA.