The federal budget law passed in July 2025, known as HR1 or the “One Big Beautiful Bill Act,” will have profoundly negative impacts on health care access and affordability, especially in rural Colorado. HR1 is beginning to show its impact with higher insurance premiums, but more significant changes will be phased in over the next seven years including higher uninsured rates, even more unaffordable premiums and out-of-pocket costs, and the closure of hospitals and clinics.