The Colorado House adopted House Bill 1309 on third reading, approving a statute that requires health benefit plans issued or renewed in the state to cover medically necessary gender‑affirming health care as prescribed by a provider.

Supporters described the bill as an equity measure that makes medically recommended care accessible to people who rely on public or private plans; opponents said the bill will increase premiums, include elective cosmetic procedures, and expose insurers and taxpayers to significant new costs. The final recorded vote was 40-20 with five excused.

Representative Caldwell, speaking against the bill, emphasized concern about coverage for minors and a list of procedures included in the statutory definition: "Now, on page 3, line 21, it says, A health benefit plan ... shall not deny or limit gender affirming healthcare that is medically necessary. ... Then explain to me why this includes children and why when we run an amendment that says you must exclude children from these procedures and these health benefit care plans, you voted down that amendment. If it's not happening, why is it in the bill?" Caldwell questioned why procedures such as genital surgery or breast/chest surgery appeared in the statute if they were not intended for minors.

Several speakers raised fiscal concerns. Representative Bradley, citing several studies and international policy changes, argued that recent evidence prompted caution, and Representative Richardson warned coverage would add to insurance premiums and that exemptions (such as removing testosterone from prescription monitoring) could undermine safeguards.

Sponsors and supporters said coverage is medically necessary for many patients and reduces mental‑health crises and emergency care use. Representative Brown, one of the sponsors, said gender‑affirming care "is medically necessary life saving care" and cited actuarial analyses that, according to sponsor statements on the floor, predict minimal premium impact in individual and small‑group markets and modest impact in the large‑group market.

The bill also contains a rulemaking directive to the insurance commissioner and language intended to ensure coverage is grounded in a provider's clinical determination and accepted standards of care. Opponents urged an exclusion for minors and for delay; sponsors said denying coverage would leave people without access and could increase suicide and hospitalization rates.

Outcome and next steps: House Bill 1309 was adopted on third reading. Implementation will involve rulemaking by the Colorado Division of Insurance and potential budgetary review for affected public programs. Debates signaled likely oversight from the legislature, insurers, and medical groups as the law is phased in.

Votes at a glance: House Bill 1309 — adopted, 40-20 (5 excused).