Hospital cost shifting is a well-documented phenomenon in which providers charge higher prices to private insurers to offset lower reimbursements from government programs. In Colorado, state reports have confirmed widespread cost shifting, yet there is no requirement to track or report whether similar effects are occurring under the Colorado Option. Lessons from Oregon show that state-imposed hospital rate caps led to significant increases in commercial insurance reimbursement rates, raising concerns about unintended consequences for private health plans. Understanding the impact of cost shifting is critical to ensuring a fair and sustainable healthcare system.