Unpacking HR-1

Brigitta Robinson, MD, FACS, CMS President

The federal HR-1 legislation – alongside the ACA Marketplace Integrity Rule passed earlier this year – is reshaping health care across the country. For Colorado physicians, these sweeping federal changes are already rippling through our state budget, coverage systems, and clinical practice environment. The effects will build over the next several years, and physicians must be ready to adapt and engage.

The big picture: A system under pressure

As the saying goes, what’s above the surface is only part of the iceberg. Beneath the visible policy shifts lie deep fiscal and administrative currents that will shape Colorado’s health system for years.

Colorado is already facing a $1.2 billion budget shortfall, compounded by hundreds of millions in additional gaps tied to HR-1’s Medicaid and ACA provisions. Health care makes up nearly 40 percent of the state budget – meaning rising costs and new federal requirements will inevitably strain other priorities like education and transportation.

Among HR-1’s most
immediate impacts

• Medicare will receive a temporary +2.5 percent conversion factor update, but the fix expires after one year, creating renewed uncertainty.
• Medical student loan caps could discourage future physicians, especially from underserved areas or underrepresented populations.

• Medicaid work requirements are expected to disenroll as many as 100,000 Coloradans, increasing uncompensated care and administrative costs.
• Enhanced premium tax credits (EPTCs) under the ACA are set to expire – jeopardizing coverage for up to 100,000 individuals and destabilizing the individual insurance market.

Colorado’s coverage strategy at risk

The Health Insurance Affordability Enterprise – built on interconnected programs like reinsurance, the Colorado Option, and OMNI Salud – relies on both state fees and federal waivers. Without continued federal tax credit support, the reinsurance program’s savings drop, slashing federal pass-through funding by an estimated $100 million and threatening market stability.

Hospitals and health plans have already warned that these changes could make participation unsustainable. Simultaneously, new federal mandates will require more frequent eligibility verifications, pushing even more Coloradans off coverage.

What’s coming next

By 2027, the hospital provider fee – which funds Medicaid expansion and helps reimburse uncompensated care – will begin to phase down from 6 percent to 3.5 percent, draining an estimated $10.4 billion from the system over five years. Additional state costs to administer SNAP and Medicaid could deepen fiscal pressure.

All of this adds up to a system under extraordinary strain. Physicians can expect to see more uninsured patients, delayed care, higher administrative burdens, and increased stress on clinical teams.

What CMS is doing now 

The Colorado Medical Society (CMS) is taking action to help physicians navigate the shifting policy landscape created by HR-1 and related federal and state changes.

• CMS’s advocacy team – supported by physician leaders and policy experts – is closely monitoring state budget developments, Medicaid policy changes, and insurance market impacts tied to HR-1. CMS continues to engage with legislators and regulators to safeguard patient access and preserve a sustainable practice environment.
• Through its communications and advocacy strategy, “Your Care is at Our Core,” CMS is collecting physician and patient stories to demonstrate the real-world consequences of policy shifts and to strengthen the physician voice in public discussions.
• Recognizing that HR-1 could drive higher uncompensated care and administrative costs, CMS is also expanding resources to help members adjust. This includes tools, peer networks, and more.
• CMS encourages physicians like you to participate directly in advocacy – responding to alerts, contributing local data, and sharing patient stories. These efforts ensure policymakers understand how proposed changes affect both physicians and the patients you serve.

In short, CMS is not waiting for the dust to settle. CMS is working now – educating, equipping, and advocating – so that when the effects of these changes reach Colorado practices, physicians are informed, supported, and ready to act.

What physicians can do now

While the challenges are significant, Colorado physicians are not powerless. The Colorado Medical Societyis working to help practices anticipate changes and advocate for solutions. Here are concrete steps physicians can take today to prepare for HR-1’s impact:

• Prepare for more uncompensated care by assessing potential increases and plan for financial resilience.
• Update your bad debt estimates to incorporate projected shifts in payer mix and coverage loss.
• Engage your finance department to review cost-sharing structures for high-impact services and clinics.
• Connect with referral sources by strengthening coordination with partners likely to see similar patient churn.
• Run a payer-mix impact analysis to identify which portions of your patient population are most vulnerable.
• Strengthen eligibility workflows by updating checklists, training staff, and maintaining up-to-date communication contacts with payers to track patients at risk for coverage loss.
• Engage with CMS, the American Medical Association (AMA), and your state specialty society. Join collective advocacy to mitigate the impact of federal and state policy shifts.
• Collecting patient stories and local data for real-world examples from your community are powerful tools for advocacy.

The path forward

The waters ahead may be turbulent, but Colorado physicians have weathered storms before. By staying engaged and working collectively through CMS, we can help shape how these federal shifts play out – protecting patients, preserving access, and sustaining the physician voice in Colorado’s health system.

As a trauma surgeon who works closely with emergency medicine, I am working hard to stay connected, prepare for the changes, and advocate for patients. CMS invites all members to stay connected, stay informed, and take the next right step for Colorado physicians and the patients we serve.