The second Trump presidency could mean big changes for health insurance in Colorado

For months while on the campaign trail, Republican leaders — including President-elect Donald Trump — have been talking about making big changes to the U.S. health insurance system.

It’s just not clear what those changes will be or how they would impact Colorado.

Declaring that “Obamacare sucks,” Trump has vowed to replace the Affordable Care Act, but he has also at other times expressed openness to keeping it. (The 14-year-old law is, of course, also known as Obamacare, given that it was passed during the Barack Obama administration.) Asked at a debate what he plans to do, Trump said only that he has “concepts of a plan.”

House Speaker Mike Johnson has pledged to get rid of the Affordable Care Act without offering specifics, other than to promise “massive reform to make this work.”

The Affordable Care Act has become deeply entwined in the health care policy of Colorado and other states, meaning that repealing it or substantially rewiring it will result in big changes. But Colorado will also have a say in how those changes hit the state.

Here’s an overview of what it might look like if the ACA were repealed.

Many of the Affordable Care Act’s coverage protections would remain

Some of the ACA’s most popular provisions are its insurance protections.

Under the law, you can’t be denied health coverage because of pre-existing conditions, and you can’t be charged more based on your health history. The ACA also requires insurers to provide a minimum level of coverage — the “essential health benefits” — so people don’t have to buy additional policies to cover, say, maternity care. (Prior to the ACA, just 12% of plans available to people who shop for insurance on their own offered maternity benefits. Most employer-sponsored plans offered maternity coverage.)

If the ACA were to be repealed, though, many of these protections would likely remain in Colorado — at least for some people. That’s because Colorado lawmakers years ago aligned state health insurance rules with those in the Affordable Care Act.

So, state law also prohibits insurers from denying coverage based on pre-existing conditions or charging more based on medical history. Annual and lifetime caps on benefits are also not allowed under Colorado law.

Protections for the essential health benefits are a little less clear because the state law that guarantees them refers to the text of the ACA to define what the benefits are.

“It would present a challenge because then we would be referring to a definition of essential Health benefits that would no longer exist,” said Adam Fox, the deputy director of the Colorado Consumer Health Initiative.

Fox said he and his colleagues are going through state law now to find potential gaps like this in the state’s protections. Those could come up for fixes during next year’s legislative session.

Another important point: These protections only cover plans subject to state law. Not all health insurance plans are, such as so-called self-funded employer plans.

Insurance subsidies could go away

People who buy plans on their own currently benefit from advance tax credits to help them pay for their insurance premiums, provided they don’t make too much to qualify. About 80% of people who shop for coverage on Connect for Health Colorado this year will be eligible for the subsidies, the state estimates.

And those subsidies can really take the sting out of insurance prices. About 77% of people eligible for subsidies will be able to find a plan on Connect for Health with an after-subsidy premium of less than $100 per month, the state says.

Those subsidies are a function of the Affordable Care Act, meaning they will go away if the law is repealed — as will certain subsidies available to people with especially low incomes that help pay other out-of-pocket costs like deductibles or copays.

Even if the ACA isn’t repealed, some portion of the subsidies could still go away. Enhanced subsidies passed during the COVID pandemic are set to expire at the end of 2025 unless Congress reauthorizes them.

Fox, with the Colorado Consumer Health Initiative, said these funding issues show how changes at the federal level could affect people in Colorado even if the protections in their coverage remain.