Colorado Democrats and health care advocates were quick to condemn the Medicaid cuts that passed the U.S. Senate on Tuesday as part of Congressional Republicans’ sweeping domestic policy bill. 

The legislation, which Donald Trump has dubbed his “One Big, Beautiful Bill,” carries much of the president’s agenda, including an extension and expansion of his 2017 tax cuts, more money for immigration enforcement and defense, and rollbacks of clean energy subsidies passed under his predecessor, former President Joe Biden. 

To help offset the tax cuts and new spending, the bill slashes social programs, including Medicaid, which is used by nearly 1 in 4 Coloradans. The version of the “big, beautiful bill” that passed the Senate on Tuesday contains even greater Medicaid cuts than what the House passed in late May. 

Spending on the health care program is now projected to drop by about $1 trillion over the next decade, according to estimates from the Congressional Budget Office. Coupled with changes to the Affordable Care Act marketplace, the bill could lead to as many as 17 million people losing health insurance by 2034, the budget office projects. 

“Everyone’s access to care will worsen as clinics and hospitals reduce services or close completely, and this will hit rural communities the hardest,” Adam Fox, deputy director for the Colorado Consumer Health Initiative, said in a statement. 

“Under this devastating bill that cuts nearly $1 trillion from Medicaid alone, hundreds of thousands of Coloradans will lose health coverage,” Fox continued. “Coloradans will become sicker without healthcare, and will include those fighting cancer, older adults in nursing homes, people living with disabilities, veterans, children, low and moderate-income families, and small businesses/entrepreneurs.”

Medicaid cuts proved to be a sticking point for some GOP Senators, with Susan Collins of Maine and Thom Tillis of North Carolina voting against the bill because of what it would mean for low-income people and hospitals in their states. 

A third Republican senator, Rand Paul of Kentucky, voted against the measure because of deficit concerns. The bill is projected to increase the national debt by more than $3 trillion, according to the budget office. 

Senators ultimately deadlocked 50-50 on the bill, with all Democrats, including Colorado’s Michael Bennet and John Hickenlooper, opposed. Vice President JD Vance cast a tie-breaking vote to pass the legislation. 

The bill now heads back to the House, where it must win final approval before it can move to Trump’s desk for his signature. Fox said Colorado’s four House Republicans, all of whom voted for the House version, “have the power and must stop this bill to protect Coloradans and our communities.”

House Republicans were able to pass their version in May by a single vote against universal opposition from Democrats. That means just one new Republican defection would be enough to sink the bill when it returns to the House floor. 

Some House Republicans have signaled they may oppose the Senate version of the legislation for various reasons, with fiscal hawks raising deficit concerns and others lamenting the additional Medicaid cuts. 

The House-passed “big, beautiful bill” contains just under $800 billion in Medicaid cuts, which are achieved through new work requirements for Medicaid recipients, restrictions on funding for abortion services, and other changes. 

One of the major cuts added in the Senate bill is a cap on provider taxes, or fees, which states use to leverage more matching Medicaid funds from the federal government. Hospital groups have lobbied to preserve the provider tax, saying they’d face major funding gaps without it. 

Rep. Jeff Hurd, a freshman House Republican representing Colorado’s 3rd Congressional District, signed onto a letter last week with 15 other House Republicans telling Senate GOP leadership, “We cannot support a final bill that threatens access to coverage or jeopardizes the stability of our hospitals and providers.” 

Hurd’s congressional district spans much of the Western Slope and southern Colorado and has the highest rate of Medicaid recipients in the state. Hurd, in a statement shared through his spokesperson on Tuesday, said the bill “is going to require significant changes in order to pass.”

“I look forward to working with leadership and my colleagues to pass a bill consistent with the promises we made on the campaign trail,” Hurd said. 

Colorado Gov. Jared Polis said in a statement, “It’s time for the House to rise to the occasion and do their part to protect Americans from this bill and start over.” 

Colorado House Speaker Julie McCluskie, along with other state-level Democratic leaders, sent a letter on Tuesday urging Hurd and Reps. Gabe Evans, Jeff Crank and Lauren Boebert to vote against the bill. 

They said the cuts to Medicaid alone would cost Colorado $1 billion, while other cuts, such as those to the Supplemental Nutrition Assistance Program, would further exacerbate a financial shortfall that the state can’t afford to fill. 

“While we understand that you do not need to balance the federal budget — as demonstrated by your votes for this bill that will increase the deficit by trillions of dollars — we do balance our budgets in Colorado,” their letter states. “We have had to make hard choices in the last year to protect core services for hardworking families, and we will have to make many more in the year ahead. However, the choices this bill will force us to make are far worse and will be devastating for our state.”

Lawmakers list several ways they may try to absorb some of the funding hits, including limiting a property tax exemption for seniors and veterans, increasing higher education tuition, reducing tax credits for working families, and scaling back health care reinsurance. 

“Colorado simply cannot absorb the financial blow your bill will strike to our budget,” their letter states.