How much more are COLORADO ACA enrollees *really* paying this year due to Trump/GOP policies?

IMPORTANT: See the original post in this series for an explanation of the methodology.

Regular readers know that I've been obsessing over the massive increases in both gross as well as net premiums for ACA health insurance policy enrollees being caused by the combination of Congressional Republicans allowing the enhanced federal tax credits to expire as well as other Trump Regime policy changes for well over a year and a half now.

I've written countless analyses of how much both gross and net premiums skyrocketed from 2025 to 2026 across different states, different income levels and various other demographics...and last week it was revealed that over 3 million ACA exchange enrollees had already been priced out of the market as of April, with the number almost certain to climb further throughout the rest of 2026.

As I've repeatedly warned, however, the increases in premium costs (whether gross or net) are only half the story. The other big shoe which is dropping this year is increased out of pocket costs as millions of the ~19.2 million or so remaining enrollees as of April have been forced to downgrade their coverage to avoid (or at least minimize) those massive premium spikes.

In most cases this means moving to plans with higher deductibles, higher co-pays & higher coinsurance costs. In many cases this has also included moving to plasn with worse networks, referral requirements to see specialists and so on.

With that in mind, that's exactly what I've decided to set out to do: Calculate the average year over year increase not just in net premiums (that is, how much more ACA enrollees are having to pay each month) but also the year over year change in average out of pocket costs.

Note that healthcare policy/data firm KFF published a new analysis of actual 2026 ACA enrollment and determined that average ACA Marketplace deductibles actually increased by a whopping 37% (or $1,027 per person) to a record high of $3,786 in 2026...which only serves to underscore the entire point of the very out of pocket cost analysis project you're reading right now!

I've been able to utilize KFF's data to estimate the average deductible for every state in both 2025 & 2026 as well, and have decided to start adding to those to the bar graphs.

Let's take a look at COLORADO.

Here's total Open Enrollment plan selections for both 2025 & 2026 broken out by raw metal level:

As I explained at length in the original post, simply looking at the official metal level breakout is misleading because a huge chunk of ACA enrollees are low-income enough to be eligible for Cost Sharing Reduction (CSR) assistance, which boosts Silver plans up to Platinum levels of AV for most CSR enrollees. You have to adjust for that in order to find the weighted average Actuarial Value, which is only down slightly year over year in Colorado:

IMPORTANT: I only have detailed CSR category enrollment data for the 30 states hosted via the federal ACA exchange, HealthCare.Gov. Unfortunately, the Centers for Medicare & Medicaid Services (CMS) only provides total CSR enrollment for most of the 21 state-based exchanges (SBEs).

For those states, I'm instead relying on rough estimates based on the percent of enrollees in the 100 - 150%, 150 - 200% and 200 - 250% FPL income brackets who selected Silver plans each year, which can be found in the 2025 & 2026 OEP State, Metal Level, and Enrollment Status Public Use Files (ZIP) from CMS.

These percentages, when converted into raw numbers, correspond fairly closely to the actual CSR category breakouts for FFM states (+ or - 5%), so they should be close enough for my purposes. I've also come up with rough estimates for the AI/AN CSR category based on comparisons of the percent of AI/AN CSR QHPs selected in FFM states to the percent of AI/AN residents within each state. This is less than 3.3% in every SBE state except for New Mexico.

Again, these are broad estimates only but should be reasonably accurate for this project.

By combining these numbers with the average gross premiums per enrollee I'm able to calculate an estimate of the average total medical expenses each enrollee racks up each year assuming an 80% average Medical Loss Ratio (which, as I stated in the original post, can vary widely by carrier and year, so this should be considered a very broad average only).

HOWEVER, COLORADO (along with some other SBE states) is a SPECIAL CASE because they're offering SUPPLEMENTAL STATE-BASED SUBSIDIES on top of the (reduced) federal tax credits this year.

Specifically:

Subsidy Structure for Households Below 400% FPL:

1. For the first enrollee in a household, the enhanced premium subsidy shall be the lesser of $80 per member per month (PMPM) or the premium balance after federal APTC has been applied.

2. For each additional member in the household who is subject to a premium, the enhanced premium subsidy shall be the lesser of $29 per member per month (PMPM) or the premium balance after federal APTC has been applied.

For households with more than three dependents under age 21, no enhanced premium subsidy will be applied for any subsequent dependents with $0 premium.

According to the official Connect for Health Colorado 2025 Open Enrollment Period report, Colorado ACA enrollees are receiving an average of $559/month in combined federal & state premium tax credits this year...and that this amounts to $10.66 million in state subsidies per month, which works out to around $38.50/month per enrollee, or $461/year per enrollee on average.

Here's what all of this looks like...note that I've subtracted $38.50/mo from the average net premiums in 2026 (blue cell):

WITHOUT the additional Colorado subsidies, net 2026 premiums would have averaged ~$318/month, or 55% higher than they were in 2025. Withe the extra financial assistance, this is knocked down to "only" a 37% average premium hike...$900 more per year per enrollee.

Meanwhile, thanks to the average actuarial value remaining mostly the same overall, Colorado enrollees look to "only" see their average out of pocket costs increasing by around 19% or so, for a combined average yearly healthcare spending increase of ~29%, or $1,263/person.

In addition, based on KFF's net data, average deductibles also went up by a relatively modest ~9% to around $3,800 for single coverage this year, and of course the maximum (theoretical) out of pocket cut-off for all ACA enrollees went up by over 15% this years as well, to $10,600 for single coverage.

Next up: CONNECTICUT.