Source Categories

Sources fall into three tiers (see Evidence Base). Tier 1 (independent government and academic data) includes the U.S. Census/ACS, CDC, CMS, the Congressional Research Service, KFF, the Colorado Health Access Survey, and administrative data from HCPF, the Division of Insurance, and CIVHC. Tier 2 (national rankings) includes the Commonwealth Fund State Scorecard and independent composite rankings. Tier 3 (Colorado stakeholder sources) includes the Colorado Hospital Association, insurers, provider associations, and consumer and patient advocates, each identified and calibrated against its interests.

Peer-State Benchmarking

Colorado is compared with Arizona, Nevada, New Mexico, Utah, and Washington, selected for shared regional geography, overlapping rural and workforce challenges, and a range of policy approaches, plus the national average. Cross-state comparisons rely on consistent-methodology sources (Census/ACS, CDC, CMS, Commonwealth Fund) rather than Colorado-specific surveys, which is why some Colorado figures differ.

Key Informant Interviews: Method and Limitations

Qualitative evidence in this report comes from a structured key informant process. Informants were selected to span government, provider, payer, and consumer perspectives on the questions the report examines, and responded in July 2026 in writing to a common set of open-ended questions tailored to each informant's sector.

Three conventions govern how this material is used. Informants are identified by sector rather than by name, because responses were given on that basis. Each is an interested party — advocacy organizations, hospital representatives, and clinic operators all have institutional stakes — and their statements are treated as informed perspective calibrated against those interests, not as independent verification. And a claim made by a single informant is attributed as such in the text, rather than described as a finding; no assertion in the Executive Summary or in Table 1 rests on interview evidence alone. Where informants made factual claims, those claims were checked against documentary sources before use, and several were not carried forward because they could not be substantiated.

Limitations and Level of Evidence

Coverage figures from the 2025 CHAS predate the 2026-2027 federal changes and are self-reported and biennial. Claims data from CIVHC lag one to two years and omit the uninsured, most federally insured residents, and some self-funded plans. Federal-impact figures are modeled estimates that depend on implementation and CMS guidance and should be read as ranges; the 2026 premium figures are DOI final rates and Connect for Health Colorado projections that vary widely by age and geography. Coverage, enrollment, premium, and budget figures rest on strong primary-source evidence; projected federal impacts and the fault-line characterizations carry more uncertainty. The fault-lines and policy-considerations sections should be read as the current state of the evidence rather than as settled conclusions, and they will be updated as further interview evidence is incorporated. Two further limitations should be noted. First, several national findings — on underinsurance, medical debt, and provider consolidation — are drawn from national datasets and applied to Colorado where state-specific equivalents do not exist; they are labeled accordingly. Second, a small number of premium and carrier-count details are drawn from commercial insurance-brokerage compilations of marketplace data; these are used only for illustrative price levels, never for the report's material findings, which rest on Division of Insurance and Connect for Health Colorado sources. Per-capita spending comparisons use the CMS State Health Expenditure Accounts, whose most recent vintage is 2020 and therefore predates the period this report examines.