Health care coverage has been in the news a lot lately, thanks to an ongoing fight in Congress. You might have heard about it, it’s over tax credits. The wonky name is Affordable Care Act enhanced subsidies for insurance premiums.
Basically the individual market is for people who don’t get health insurance from their employer or through a government program like Medicaid or Medicare.
According to the non-partisan Colorado Health Institute, roughly 7% of Coloradans get insurance this way, often buying a plan on the state’s marketplace, called Connect for Health Colorado, which is the only place to get subsidized premiums.
After five years of record growth, enrollments in health insurance plans on the marketplace in Colorado dropped by 2% this year. Despite rising costs due to less federal financial assistance, about 277,000 Coloradans enrolled in health insurance.
The Colorado Health Institute has been tracking Colorado’s health insurance landscape for years, since before the Affordable Care Act, also known as Obamacare, launched in 2014, asking Coloradans questions in its Colorado Health Access Survey. This month it released an analysis of the individual market.
Data from the 2025 survey show that almost 100,000 Coloradans report that they get coverage through Connect for Health Colorado and have incomes above 400 percent of the poverty line.
“People in this group are seeing significantly higher costs for their coverage,” the analysis found.
“While many of these Coloradans are considered middle-income, the loss of the enhanced subsidies can be substantial because some of these families are still not earning what is considered a living wage in Colorado — $137,000 annually for a family of four.”
In its report, Colorado Health Institute broke down question responses by insurance type and found folks enrolled in the individual market were less happy with the health care system, likely due to ongoing issues, like “the high costs of care, barriers to accessing providers, and coverage stability.”
Since 2023, about half of individual market enrollees reported satisfaction with the health care system, it found. That’s lower than those covered by employer-based insurance, Medicaid/Child Health Plan Plus (CHP+), and Medicare.
“Individual market enrollees are consistently dissatisfied or unhappy with the health care system,” said Chrissy Esposito, Colorado Health Institute research and programs manager.
“The common thread that we see trending with that unhappiness is the cost being a barrier to getting care.”
CPR Health Reporter John Daley interviewed Esposito. This interview has been edited for brevity and clarity.
Chrissy Esposito: The No. 1 takeaway from our analysis is that the cost and affordability issues for individual market enrollees does not stop at the cost of buying the insurance plan. And it really extends into the cost of getting care. And individual market enrollees are skipping care due to cost at much higher rates than other insurance types like Medicare, Medicaid, and employer sponsored insurance.
John Daley: So people who are buying health insurance in plans oftentimes feel they need to have insurance, but once they get that insurance, it really doesn’t always cover a lot of what they would love to use it for and then they’re left paying out of pocket?
Esposito: Correct. So they’re buying the plans, they’re getting their foot in the door, and then when it comes time to actually get care, whether it be a primary care provider or specialist or dentist, they’re pulling on the reins and they’re being like, ‘my out-of-pocket max or my deductible is too high, I’m gonna forego care for right now.’
Daley: And we’ve had the marketplace in Colorado for more than a decade. Have the views of the cost issue changed in that time?
Esposito: So we’ve looked at views of the health care system, and they have been over time constantly dissatisfied with the health care system. Individual market enrollees are consistently dissatisfied or unhappy with the healthcare system. And the common thread that we see trending with that unhappiness is the cost being a barrier to getting care.
Daley: So even though they have insurance, it’s not really enough.
Esposito: More needs to be done so people can actually get the care with the insurance plan that they have.
Daley: Can you tell me more about what your analysis found?
Esposito: So in addition to cost, we also know that finding a provider who takes your insurance is particularly hard for individual market enrollees. A lot of enrollees are saying that when they went to go get care, the doctor did not take their insurance. And so they’re having to look to other networks or even outside of their community to get even basic care, like seeing a general provider for a wellness checkup.
And then we also found that there’s coverage instability. So there’s a lot of people coming to the individual market who may have lost their job or their employer insurance, or they may have rolled off Medicaid. And so people have had a lot of instability in their insurance plan over the past year, which can mean you have to find a new provider and you can just have a lot of discontinuous services when you have to find someone else to help you provide your care for you or your kids. So those were some of our other findings.
Daley: If it’s hard to find a provider and you’re scrambling around to do that, then that really undermines the whole point of having insurance, right? It’s another barrier to getting good health care?
Esposito: Exactly. So you have the cost issue, then you have the find a provider issue. And I think a lot of times when it comes to trying to find a provider who accepts your insurance, we hear that a lot from Medicaid, or people who are enrolled on Medicaid. But it’s also happening with people who have individual market insurance. So we want to highlight that it’s becoming a more widespread issue on our insurance landscape and it’s not just impacting our Medicaid folks.
Daley: For a lot of people, this might be disappointing because there was a lot of hope both in Colorado and nationally, that creating these marketplaces would give people this other ideally more affordable option to getting health care.
Esposito: It’s working when it comes to buying the health care plan. So a lot of what the ACA did was added those subsidies so people could afford those monthly premiums. And a lot of those are still happening. We just know that the enhanced subsidies, which is for folks with middle to higher incomes, are no longer there. So it’s working in a sense that more people can buy the plan, but we are still seeing that disconnection to having care be at an affordable cost for people.
Daley: Does your analysis get into potential solutions to this?
Esposito: We want to work with other folks to really think through some of these solutions. This is more than just what CHI (Colorado Health Institute) can propose. This is going to take a lot of work with state legislators and federal officials to truly understand how we can make this better for Coloradans? It’s going to be a group effort.
Daley: Are you aware of other states that have been able to thread this needle a little bit better than Colorado?
Esposito: We haven’t looked into that yet, but as we’re really looking at these cost issues, that’s something that we are going to be exploring more later this year.
Daley: One of the interesting things with insurance is that Colorado, in part because of the marketplace and also expansion of Medicaid, was getting closer and closer to having almost everybody insured.
Esposito: It is great. We have made a lot of dents into our uninsured rate and that may, that rate might stay as it is. It’s just, like I said before, we’re getting people in the door, we’re getting them covered, but then we’re kind of leaving them hanging with the cost for services. And so I would always encourage people to look at that uninsured rate and say, “Great. 94%, 95% of people have insurance,” but what happens after?
We need to be thinking about the next step. Let’s get them insured and then let’s make sure they can get the services and care they need for a price that makes sense for themselves and their family.
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