Major changes are coming to health insurance in Colorado over the next two years, but members of the state’s delegation in Congress are pitching bills that would dampen the impacts of those disruptions to health care.

H.R. 1, known as the “Big Beautiful Bill,” will reduce the number of people covered by Medicaid by adding work requirements and making enrollees prove their eligibility more frequently. It will also limit states’ ability to expand the services their Medicaid programs pay for, starting in 2027.

The number of uninsured people in Colorado and across the nation will likely start to rise before then. Higher subsidies to buy insurance on the individual marketplace, put in place during the pandemic, will expire Dec. 31.

In a letter to Colorado’s delegation this week, Gov. Jared Polis estimated premiums for people who previously received the subsidies will double across the state and quadruple in parts of the Western Slope and Eastern Plains.

“Colorado has done everything we can at the state level to blunt the damage of H.R.1 and the loss of the tax credit, but only Congress can stop these massive premium increases and the resulting loss of coverage for hundreds of thousands of hard-working Coloradans and their families,” said the letter, which Lt. Gov. Dianne Primavera also signed.

The state’s delegation split along party lines on H.R. 1, with all Republicans supporting President Donald Trump’s signature piece of legislation and all Democrats in opposition.

Congress faces a busy month. If it doesn’t pass a spending bill, or more likely, a short-term extension of current spending, the federal government will shut down Oct. 1. The need to avoid a shutdown could make it difficult for lawmakers to pass any other bills, or create an opportunity for anyone who can fold their bills into must-pass legislation.

While Republicans have majorities in both chambers, they need votes from Democrats to get a spending bill through the Senate, giving the minority party some leverage to include its own priorities. Republicans can’t concede too much, however, without losing votes from their more fiscally conservative wing.

Rep. Jeff Hurd, who represents the 3rd Congressional District on the Western Slope, is one of a group of 10 Republicans sponsoring a bill to extend the expiring subsidies to purchase coverage on the individual marketplace for one more year.

The backers called for a “sustainable” plan to end the subsidies without raising costs for customers, but didn’t offer any details about how they would do so.

A spokesman for Hurd, who declined to be identified, said the group is looking to pass the bill as quickly as possible to avert an increase in rates and give lawmakers space to come up with a longer-term plan. Ideas include gradually reducing the subsidies over time, or pairing any further extension with efforts to bring down the overall cost of health insurance, he said.

Rep. Brittany Pettersen, who represents the 7th Congressional District in the western Front Range and eastern mountain region, said Democrats would prefer to make the enhanced subsidies permanent, rather than create uncertainty about whether Congress will extend them every year.

Still, a short-term extension is better than nothing, she said.

A one-year extension would mean that any increase in costs would hit after the 2026 midterm elections. An analysis from August found that if subsidies expire at the end of the year, premiums could go up by a median of 18% nationwide, meaning half would rise by less, and half by more.

The previous year’s median increase was 7%, according to the health policy nonprofit KFF.

Democrats are trying to chip away at what they consider some of the worst policies in H.R. 1, Pettersen said.

She plans to announce a bill that would repeal language requiring that any Medicaid “waivers” be immediately budget-neutral. Currently, states can add benefits to their Medicaid programs if they show budget neutrality or savings over the long run, she said.

For example, Colorado’s waiver allows the state to pay for inpatient care for mental illnesses and addictions, which Medicaid doesn’t typically cover, Pettersen said. Sixteen other states have the same ability to cover inpatient mental health care, and 37 cover inpatient addiction treatment.

Providing that care can look expensive in the short term, but it saves lives, as well as money, when people enter recovery and stop cycling through emergency rooms, she said.

“We have a long way to go to start picking apart the most harmful provisions,” she said.

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