As administrators of Colorado hospitals/health systems serving patients with the highest needs, we are constantly in a fiscal battle to provide care to those who show up at our doors.

In that mission, Medicaid has been a lifeline to providers like us, assuring a baseline of care and keeping health care services available in some of the hardest-to-reach areas of the state.

While every program deserves scrutiny, and every health care dollar should be spent wisely, it was never controversial until recently that Medicaid was valued at the state and federal levels and should be supported.

After Congress passed its 2025 budget bill, the so-called One Big Beautiful Bill, or HR1, providers like ours began preparing for a seismic hit to our budgets, with new requirements taking effect in 2027 and dramatic revenue changes to follow.

These spending cuts — approximately $1 trillion over 10 years — were part of the budget Congress passed to offset revenue lost from tax cuts.

So it is with confusion and frustration that we hear politicians who voted for these cuts tell Coloradans they do not exist.

Some Republicans assert that Congress had not only not cut health care funding, but had actually increased it. That is simply not true.

And, in terms of HR 1 impacts, it is the mantra “fraud, waste and abuse” that continues to be the tune that is sung.

Let’s face the facts: Medicaid and Medicare do not fully reimburse the providers of care for the cost of the care they provide.

This is well-documented by numerous studies by independent think tanks.

Our elected leaders are free to make their case to voters that the government should spend less on health care.

However, the one thing they cannot credibly argue is that the cuts they voted for are not happening. Estimates from the Congressional Budget Office state that 13 million people in the U.S. will lose coverage via this law (a number that jumps as high as 17 million when considering other policy changes like the loss of ACA credits), including an estimated 175,000 Coloradans.

As the people charged with implementing these changes, we are seeing these impacts.

In the second quarter of this year, hospitals provided $288 million in charity care, a 117% increase compared with the same quarter in 2022 when it was $133 million, according to the Colorado Hospital Association.

Denver Health is preparing for an estimated $65 million annual budget impact from federal actions. And some of the most devastating financial changes for Colorado’s safety-net hospitals are still ahead, including restrictions on provider payments beginning in 2028.

Rural and Frontier hospitals in Colorado account for about 18% of uncompensated care, while only about 12% of the population lives in these areas.

Like Denver Health, which accounts for about 24% of the uncompensated care in the state, these institutions will be impacted disproportionately by the changes brought about by HR1.

At Lincoln Health, we estimate the total impact to be close to $2 million annually. Lest that amount be discounted because of its relative size, that accounts for approximately 8.5% of our expected total patient service revenue.

This is at a time when other sources of revenue are being cut.

Some federal policymakers have tried to argue that the Rural Health Transformation fund constitutes a 50% increase in Medicaid payments for the nation’s rural health providers.

Nothing could be further from the truth.

Yes, it is true that Congress allocated $50 billion over five years to be invested in rural health “transformation.” Unfortunately, the direct cuts to rural providers expected from HR1 are expected to approach $150 billion.

The Rural Health Transformation fund dollars are explicitly prohibited from being used to replace lost revenue as a result of the One Big Beautiful Bill.

These are not abstract numbers to all of the hospitals caring for Colorado’s most vulnerable patients.

They represent real financial pressures on the institutions responsible for delivering care, regardless of whether patients have the means to pay.

Our elected leaders owe us honest answers about their decisions, especially when those decisions affect so many of the people they represent.

If their health care cuts are justified, then defend them on the merits. But do not tell us to ignore what is happening around us.

Donna Lynne is the chief executive officer for Denver Health and Hospital Authority, and Kevin Stansbury is the chief executive officer of Lincoln Health in Hugo.