Lilia Cervantes knows that providing health care to immigrants is a battle of unanticipated consequences.
Years ago, as a young hospitalist at Denver Health, Cervantes watched the consequences unfold for Hilda, an undocumented mother of two young children who had come to the U.S. from Mexico. She was suffering from kidney failure, an ailment typically treated by thrice-weekly hemodialysis. Undocumented, uninsured and unable to pay out of pocket for recurring treatment, Hilda could only access the life-saving treatment once a week. Going without care, Cervantes says, left her patient “near-death” each week.
Hilda was able to receive this care under the Emergency Medical Treatment and Labor Act, a federal law that requires providers to stabilize all patients, regardless of factors like their insurance or documentation status. While many categorizations of immigrants generally are not eligible for traditional Medicaid, hospitals can be reimbursed for their care through a program known as emergency Medicaid.
But the law, known as EMTALA, requires no more than the bare minimum of life-saving emergency care. So each week, Hilda arrived at Denver Health to be revived. Eventually, after multiple cardiac arrests, the cycle became too much.
“She made a difficult decision as a mom to stop receiving emergency once-weekly dialysis, because she didn’t like the psychosocial distress her children faced, not knowing if their mom would make it to the following week,” Cervantes said. “She found adoptive parents for them, stopped emergency dialysis and died on Mother’s Day in 2014.”
Today, more than a decade later, Cervantes is an internal medicine physician and an instructor at the University of Colorado’s Anschutz School of Medicine. Four presidential terms have ended or begun anew, with both Republicans and Democrats moving in and out of the White House, promising improvements to health care infrastructure and solutions to the ever-controversial immigration debate. Through it all, she’s watched patients like Hilda struggle to access vital care due to their immigration status.
Then, she’s watched some of them die.
But children without their mother or a young woman’s death by preventable causes aren’t the only consequences that, experts say, are created by health care barriers facing immigrant patients.
New challenges under H.R. 1
The passage last summer of President Donald Trump’s tax and spending bill, known as the One Big Beautiful Bill Act, or H.R. 1, has left Colorado’s immigrant community and health care professionals facing new obstacles. The aftermath, they say, could impact Coloradans from all walks of life through budget changes for hospitals and clinics, overwhelmed care providers and increasing numbers of the uninsured.
“The big picture is that when the most neglected and marginalized groups have no access to care, it’s not only that they’re more ill, but we are as a society more ill,” Cervantes said.
In part, the GOP’s bill looks to reform policies at the intersection of immigration and health care — two issues that ranked in the top five concerns Coloradans want to see their state government address, according to a November poll by the Colorado Polling Institute.
“Health care is dominating the Colorado budget in terms of where the money is going,” said Kelly Caufield, the executive director of the Common Sense Institute, a nonpartisan research organization. “We are spending more and more at a time where health care expenses continue to increase, and we have fewer health insurance options available. It feels like something’s not working.”
Primarily, H.R. 1 addresses these spending concerns through key changes to Medicare and Medicaid. Beginning in October 2026, refugees and asylees will no longer be eligible for these federal insurance programs, along with noncitizens in some other categories. In all, an estimated 7,000 lawfully present immigrants are expected to lose coverage in Colorado due to eligibility changes. Meanwhile, an estimated 375,000 people could be impacted under other provisions, like mandatory work requirements.
But these newly uninsured patients won’t be the only ones feeling an economic pinch. When patients lose their insurance coverage, hospitals lose a vital source of income.
“Health care is kind of a circular economy,” explained Priya Telang, a spokesperson for the Colorado Consumer Health Initiative. “Everything has an impact.”
Deydra Bringas, a spokesperson for Denver Health, said the hospital expects to see its yearly uncompensated care costs rise as a result of H.R. 1.
“Denver Health estimates that at least 20,000 of our Medicaid patients could become uninsured,” she said in a statement, referring to all Medicaid patients, not just those who are immigrants. “Combined with the potential elimination of the federal government’s enhanced premium subsidies, safety-net health systems like ours are likely to see a significant increase in uninsured patients and uncompensated care costs.”
How that might impact hospital services is largely unclear, she said.
“We are still assessing the long-term implications,” Bringas said. “It’s too early to know exactly how this could affect future operational decisions, but our priority is always to protect access to essential services for the community.”
Experts say the burden on hospital systems are another unexpected result of the barriers limiting immigrants’ access to traditional care resources. When preventative care measures are inaccessible, conditions can go unchecked and untreated. This leaves some patients arriving at a provider for the first time in a serious, life-threatening state, triggering EMTALA and racking up expensive medical bills.
“Folks will primarily rely on emergency care and emergency Medicaid, which also just is a higher cost of care,” Telang said. “Folks are going to delay their care. They’re going to wait, wait, wait until it’s an emergency, and then when they go to the emergency room, it’s just going to be a higher level of care, and it’ll really hurt our health care providers.”
Past economic reforms
In caring for Hilda, Cervantes saw the economics of such a care plan in action — one she called “very expensive, unnecessary (and) low quality.”
“She’d have to come in through the emergency department, be seen by an emergency medicine physician and then have labs drawn,” Cervantes explained. “Then, they would call a hospital medicine physician to come and see the patient and admit them. Then they’d have to call in a urologist to do the dialysis.”
Even before meeting Hilda, she’d long questioned the practice.
“When I was in residency, and then once I was working as a physician at Denver Health, I just kept asking, ‘Why are we doing this? It makes no sense… It’s so much work and so costly,” Cervantes said. “The response I kept getting was ‘That’s how it is.’”
Denver Health, she said, was supportive of making changes to better support their patients.
So in 2019, Cervantes helped lead a statewide effort to reform emergency Medicaid to include dialysis for patients with end-stage renal disease. The expansion allowed patients like Hilda to access regularly scheduled treatment, while saving Colorado money. It reduced costs from around $20,000 per patient per month for emergency dialysis treatments in 2017 and 2018 to an average of $5,574 per patient per month in 2021.
But now, emergency Medicaid has been caught in the crossfire of federal budget cuts. It is unlikely that the program will be canceled, but H.R. 1 does cut the government’s share of reimbursement, which currently ranges from around 50% to 90%, depending on the patient.
“This is going to have an effect for years.”
Emergency Medicaid treatments for noncitizens account for a relativelysmall portion of Colorado’s total health care budget, costing just over $118 million out of a nearly $14 billion budget.
But with federal contributions to emergency Medicaid dwindling, state governments, hospitals and individuals will be left to pick up the slack. Despite the program’s small size, the strain — combined with the addition of others who could lose their coverage in the coming years — could still have mighty consequences.
“(Hospitals) can’t close their doors to the emergency care that they provide, but they will change their pricing and the way that people pay for their care,” said Laura-Elena Porras, the health policy and coverage program director at a clinic in Littleton. “That impacts the whole health care system and the economic side of it.”
Porras explained that, if hospitals have to raise prices, more people will depend on alternative care sources like community health centers. At the same time, these resources are suffering from funding cuts of their own.
Colorado currently has 20 different community health centers that operate 247 clinic sites throughout the state. Many of these are federally qualified health centers, which receive federal dollars to provide care in underserved communities and receive the bulk of their patient revenue from Medicaid or Medicare payments. Porras said that these centers will be particularly vulnerable given H.R. 1’s cuts to both programs.
“That is putting a lot of federally qualified health centers at a strain,” she said.
Budgeting for the 2026 fiscal year was especially challenging.
“When you’re making that budget, you cannot account for Medicaid, because you don’t know if you’re going to have that money next year,” Porras explained.
Like traditional hospitals, federally qualified health centers may have to provide more charity care if the number of uninsured Coloradans rises.
“Knowing the economics of it is the terrifying part for me,” Porras said.
She has witnessed a change in these clinics’ business model, which she attributes to economically leaner times. Many clinics traditionally offered short appointment slots online, allowing busy community members to plan exactly when and where they could receive care. Now, Porras says that she’s seen a shift to walk-in only appointments, potentially increasing wait times and discouraging people from seeking care.
Some patients, she said, will now have to ask: “Do I have time to take time off from work and also get child care for myself to get access to health care?”
Porras explained that the domino effect won’t end there. With many patients now unable to visit these centers or traditional hospitals, she expects to see an increase in the number of patients visiting safety net clinics like Doctors Care, where she works. These clinics, like federally qualified health centers, primarily serve underresourced communities, but don’t receive federal funding to do so.
“That charity care that we have to serve is going to increase for us as a safety net clinic, and so that’s what we’re seeing on the ground. Now my organization is having to prepare for all of that uncompensated care that we’re going to start providing,” she said. “This is going to have an effect for years.”
Changes to Colorado’s insurance programs
Federal health care programs aren’t the only ones expected to take a massive hit in the near future.
Colorado currently offers more expansive care options for immigrants than most other states, primarily through two programs paid into by the state. Cover All Coloradans is a Medicaid expansion that provides health insurance to pregnant people and children under 18 who would qualify for Medicaid but for their immigration status. OmniSalud is a private insurance program that allows Coloradans to purchase health insurance at state-subsidized rates, regardless of their immigration status.
Each year, a select number of people are eligible to enroll in OmniSalud’s SilverEnhanced Savings Plan, which offers $0 premiums for those who make below 150% of the federal poverty level, which is $23,475 for a single person and $48,225 for a family of four. As a ripple effect following federal funding cuts, the number of spaces eligible in the plan was slashed, leading the state to implement a random lottery system for potential enrollees. That lottery was decided on Nov. 17.
Last year, Colorado had funding for 12,000 people to receive the SilverEnhanced Savings.
“For 2026, the state only has funds for 6,700 people,” explained Aracely Olvera, a Denver-based health insurance broker.
In the past, Coloradans receiving these savings could renew their plans for the next year, so long as they still qualified. Now, around 44% of the plan’s 2025 enrollees have lost this option moving into 2026.
“There’s this whole population that’s just going to now require or rely on emergency Medicaid,” Cervantes explained.
Gabriel, an asylum-seeker from Colombia who asked to be identified only by his first name due to safety concerns, has been a recipient of OmniSalud since 2024. In November, he entered the statewide lottery and was selected to renew his plan.
The renewal is a godsend, and not for the first time.
By the time Gabriel, who settled in Fort Collins, first received OmniSalud coverage in 2024, he had been experiencing pain for months. The day after his application was approved, he underwent surgery to treat long-undiagnosed appendicitis.
“I was very lucky,” he said.
This time around, the insurance program will buy Gabriel more than just a procedure: it buys him time. He currently needs surgery to treat a hernia, but can’t seek treatment because he also cares for his ailing mother.
“In this moment (my brothers and I) are keeping my mom company because she has cancer and she’s already in a terminal state,” he said. “I cannot schedule the surgery until she’s gone.”
He’s insured for another full year now, allowing him to both say goodbye to his mother and receive the care he needs. But between the state’s announcement that OmniSalud would be downsizing and the lottery drawing, Gabriel braced himself to choose between his own care and his mother’s.
It’s a consequence of OmniSalud’s cuts that, Olvera explained, is far from unique. And unlike Gabriel, thousands will now find themselves uninsured in 2026 and facing similarly wrenching choices.
“People are going to have to choose whether I pay my mortgage or I pay health insurance, and most of the time it’s going to be their mortgage and groceries,” she said.
Coloradans respond
These looming impacts have left Colorado’s immigrant community and care providers alike experiencing a whirlwind of emotions: fear, anger and, for many, a desire to step in.
Julissa Soto, a Latino health equity consultant, works statewide to promote health care access in immigrant communities. Through pro-vaccination church sermons she calls “vaccine Sundays” and traveling health fairs, she tries to offer immigrant patients accessible alternatives to traditional health care providers.
“We provide A1C (blood sugar) screenings, cardiovascular screenings, cancer screenings, mammograms,” she said of her mobile health clinics. “It’s like having a big hospital on wheels.”
Soto’s work also extends beyond organizing care for patients and into other forms of advocacy. In October, she attended Colorado’s annual State of Reform Health Policy Conference to speak on a panel about health care access for marginalized communities, including immigrants.
“When you’re an activist, and you have that in your blood, you will not back out for anything in the world,” Soto said. “To the contrary, you will build those bridges. You will build more programs … We serve those communities that don’t have a voice.”
She explained that, through work like her own, organizations across the state are stepping up to fill the gaps they feel forming.
“We are all taking that responsibility … it’s been thrown at us, but we’re also united organizations that you have never seen working together, now you’re going to start seeing us working together for the health care and the betterment of the community,” she said.
It’s a daunting mission, but one that she feels prepared for.
“For me, as an immigrant, nothing has been easy. I crossed the border in the trunk of a car. So, I compare to where I come from, and I continue to be hopeful that things are going to change, because I come from real struggle,” said Soto, who is now a U.S. citizen. “I’ve been doing this for 30 years now, so this is not my first round, and it will not be my last one.”
The health fairs and the vaccination clinics-turned-parties — Soto says she often brings tacos and a clown — don’t just treat patients and send them on their way. They aim to mitigate one of H.R. 1’s oft-cited consequences: fear and mistrust within the health care field.
“It’s a space where I know my community understands that the person who’s organizing these health fairs look like them, speak like them and was undocumented like they were,” Soto said.
Similar fairs exist throughout the state, sharing in Soto’s mission of community building. At one health fair hosted by the social services organization Servicios de la Raza in Denver in October, a table offered patients brightly colored conchas while a DJ played Latin music. Just feet away, booths provided services ranging from dental cleanings to insurance at a station manned by Olvera.
For Cervantes, this advocacy is as vital as health care itself.
“If we don’t lean in now to change this, we are complacent and complicit,” she said.
These days, H.R. 1 has spurred a more personal consequence in her life: she thinks of Hilda with increasing frequency.
But sitting in her office, beneath a lifetime of medical awards and shelves full of trinkets, she worries for more than just the Hildas of the world; she worries about all Coloradans, both documented and not, who she says will be seeing the impacts of H.R. 1
“This has direct consequences on U.S. citizens, “ she said. “I think it’s in our best interest, or our bipartisan, mutual best interest, to make sure that the most excluded are healthy.”
Juanita Hurtado Huerfano contributed translations to this reporting.