One difficulty will resolve Steven Cohen’s vote for Nevada governor this fall: Which candidate can greatest defend him from getting kicked off Medicaid?
Cohen is a 38-year-old Las Vegas resident with autism and has twin enrollment in Medicaid and Medicare. He mentioned he’s very involved that he might lose his Medicaid protection as soon as work necessities and extra frequent eligibility checks take impact in January, beneath congressional Republicans’ One Large Lovely Invoice Act.
“If you’re going to some suppliers, notably psychological well being, as soon as a month, or within the case of 1 supplier, a few instances per week, these copays rapidly add up,” Cohen mentioned.
Republican Gov. Joe Lombardo is operating for reelection in a good race towards Democratic state Lawyer Normal Aaron Ford in one among 39 U.S. gubernatorial elections to be determined in November. Lombardo has President Donald Trump’s endorsement, however healthcare coverage modifications made by the Trump administration are working towards him with voters like Cohen within the swing state.
These modifications embody Medicaid funding cuts which are anticipated to pressure state budgets, together with new work requirement and eligibility guidelines for Medicaid and the Supplemental Vitamin Help Program, which offers meals help for low-income households. The modifications are anticipated to extend the variety of folks with out medical health insurance nationwide by an estimated 7.5 million in 2034 and reduce the quantity of people that obtain SNAP by 2.4 million folks in a mean month from 2025 to 2034.
Individuals throughout the U.S. have additionally been feeling the pinch of rising medical health insurance premiums since Congress allowed enhanced Inexpensive Care Act subsidies to run out on the finish of final yr. Many who buy well being plans on the ACA market have chosen inexpensive plans with much less protection or are going with out insurance coverage altogether.
These modifications could have a major affect in Nevada, the place tourism, hospitality, and gaming are cornerstones of the state’s financial system. Practically 300,000 folks in Nevada are self-employed, impartial contractors, or freelancers with out employer-sponsored medical health insurance advantages. Many buy insurance coverage via the state’s ACA well being trade, which noticed a 5.5% lower in enrollment this yr after a report 110,000 folks signed up for 2025.
Even earlier than the federal modifications, Nevada’s 11.4% uninsurance price was already the fourth-highest within the nation, in keeping with information from 2024. A state Medicaid official instructed lawmakers in Could that an estimated 70,000 Nevadans might lose their Medicaid protection beneath the brand new guidelines. Round 28,000 folks within the state misplaced entry to SNAP in Could.
“That is going to return right down to an affordability election, and that’s going to harm the Republicans,” mentioned David Damore, a professor within the political science division on the College of Nevada-Las Vegas.
In a nationwide KFF ballot this yr, two-thirds of respondents mentioned they have been fearful about affording healthcare, greater than mentioned the identical about meals and groceries, housing, or fuel. And greater than half mentioned their healthcare prices had elevated prior to now yr. KFF is a well being info nonprofit that features KFF Well being Information.
Whereas most respondents mentioned that healthcare prices will affect whom they vote for in November, the difficulty was extra urgent amongst Democrats and independents.
Aggressive gubernatorial races are additionally underway in Arizona, Georgia, Iowa, Michigan, and Wisconsin, with all these races thought-about toss-ups.
The Democratic Occasion has the sting on healthcare points over Republicans, however about 3 in 10 voters reported that they don’t belief both occasion, famous Liz Hamel, a senior vice chairman and the director of public opinion and survey analysis at KFF.
“It’s not an awesome benefit,” she mentioned.
Not Your Textbook Republican Governor
Lombardo’s marketing campaign has touted his help for a kids’s hospital set to be inbuilt Las Vegas; his consolidation of the state’s Medicaid program, ACA market, and public worker advantages program right into a single company; and the growth of the variety of group behavioral well being facilities within the state throughout his time period.
Earlier than operating for governor and unseating Democrat Steve Sisolak in 2022, Lombardo served eight years as sheriff in Nevada’s Clark County. Earlier than that he spent 26 years with the Las Vegas Metropolitan Police Division.
Lombardo has taken healthcare stances in his first time period that diverge from the everyday Republican playbook. For instance, he mentioned in 2022 that he would oppose a nationwide abortion ban, and in 2023 he signed into legislation a Democratic-led invoice prohibiting state businesses from cooperating with different states looking for to prosecute folks for touring to Nevada to get an abortion.
The governor additionally signed payments into legislation in 2023 that prohibit insurance coverage corporations from participating in gender discrimination and require state correctional services to make sure larger protections for transgender and nonbinary folks, together with setting requirements for medical care and psychological well being therapy.
Extra lately, Lombardo has taken actions extra aligned with the Make America Nice Once more motion. In 2025, he vetoed a invoice that might have created protections for clinicians who present gender-affirming care. This yr, he endorsed a proposed constitutional modification to ban transgender athletes from ladies’ and ladies’s sports activities.
Lombardo’s marketing campaign declined to make the governor accessible for an interview for this report. In a March interview with Jon Ralston, CEO of the nonprofit information outlet The Nevada Unbiased, Lombardo mentioned he was shocked throughout his first time period as governor by how “sophisticated” and “encompassing” healthcare is, and by the “value of it.”
“Authorities appears to complicate a few of these larger processes most of the time,” Lombardo mentioned, “however on this case, they’re instrumental within the success or failure of healthcare and the way folks endure because of dangerous selections.”
His opponent, Ford, started his political profession as a Nevada state senator and have become the state’s first Black lawyer basic in 2019.
Ford has talked about how he raised his eldest son on his personal whereas attending Texas A&M College. He mentioned he relied on public advantages corresponding to Part 8 housing, Medicaid, meals stamps, and the Girls, Infants and Kids program to offer for them.
He mentioned due to these experiences, his ideas go to the Nevadans anticipated to lose Medicaid protection every time he hears a reference to the “Large Lovely Invoice.”
“It hits me otherwise,” Ford mentioned.
His marketing campaign’s “Inexpensive Nevada” plan requires decreasing prescription drug prices, boosting consciousness of the state’s public-option well being plans that debuted this yr, and canceling medical debt.
A Referendum on Trump?
Most voters who responded to KFF’s ballot mentioned they’ve little or no confidence in how the Trump administration is addressing the price of dwelling.
“It looks like, if something, the Trump administration’s method will not be going to assist Republicans within the midterms,” Hamel mentioned. However, she added, “November is many months away. Numerous issues might change.”
Lombardo seems to be distancing himself from the president amid hovering fuel costs and broader affordability points.
When Trump visited Las Vegas in April, Lombardo didn’t attend the occasion. The governor later issued an announcement that he could be assembly with the president throughout his go to, however Politico reported they spoke solely by cellphone. Damore mentioned he doesn’t suppose it was an accident that Lombardo didn’t seem with the president publicly.
“Lombardo has carried out a pleasant job making an attempt to string the needle between himself and Trump,” he mentioned.
However Ford has a neater highway forward relating to campaigning for healthcare points, Damore mentioned.
“He simply form of has to say, ‘I’ll do higher,’ and level the finger at Trump and say, ‘The place is Lombardo preventing this sort of stuff?’” Damore mentioned. “That’s a fairly straightforward marketing campaign for him.”
Partisan Nevada voters are practically evenly cut up between the 2 events, however the majority are registered as nonpartisans, most likely as a result of the state’s computerized voter registration program makes “nonpartisan” the default choice for residents who register on the Division of Motor Automobiles. As of final yr, voters can now not select a celebration on the DMV, as an alternative needing to fill out paperwork their county election workplace mails after they register.
Clark County, residence to Las Vegas and practically three-quarters of Nevada’s inhabitants, leans Democratic. The subsequent-largest county by inhabitants is Washoe County, which is residence to Reno and is the one swing county within the state. The remainder of the state is rural and persistently votes Republican.
However voters in Nevada are fatigued, Damore mentioned, after years of inflation and rising prices because the covid pandemic.
“Individuals are simply form of surly,” he mentioned. “They maintain form of ping-ponging backwards and forwards between the events. It doesn’t appear to alter a lot.”
Cohen, the Las Vegas voter, is a registered nonpartisan. He mentioned he plans to vote for Ford as a result of he’s the candidate who appears most prepared to work to guard Medicaid enrollees.
“Generally the one method to get one thing carried out, to guard it, is to sue,” Cohen mentioned. “I believe he’ll deliver that background.”
Are you struggling to afford your medical health insurance? Have you ever determined to forgo protection? Click on right here to contact KFF Well being Information and share your story.
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