One problem will determine Steven Cohen’s vote for Nevada governor this fall: Which candidate can finest shield 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 Huge Stunning Invoice Act.
“When you’re going to some providers, notably mental health, once a month, or in the case of one provider, a couple of times a week, those copays quickly add up,” Cohen mentioned.
Republican Gov. Joe Lombardo is operating for reelection in a decent race towards Democratic state Legal professional Basic Aaron Ford in one in all 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 gives meals help for low-income households. The modifications are anticipated to extend the variety of individuals with out medical insurance nationwide by an estimated 7.5 million in 2034 and reduce the quantity of people that obtain SNAP by 2.4 million individuals in a mean month from 2025 to 2034.
Individuals throughout the U.S. have additionally been feeling the pinch of rising medical insurance premiums since Congress allowed enhanced Reasonably priced Care Act subsidies to run out on the finish of final 12 months. 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 can have a big impression in Nevada, the place tourism, hospitality, and gaming are cornerstones of the state’s economic system. Practically 300,000 individuals in Nevada are self-employed, impartial contractors, or freelancers with out employer-sponsored medical insurance advantages. Many buy insurance coverage via the state’s ACA well being change, which noticed a 5.5% lower in enrollment this 12 months after a file 110,000 individuals signed up for 2025.
Even earlier than the federal modifications, Nevada’s 11.4% uninsurance charge was already the fourth-highest within the nation, in keeping with information from 2024. A state Medicaid official instructed lawmakers in Might that an estimated 70,000 Nevadans might lose their Medicaid protection beneath the brand new guidelines. Round 28,000 individuals within the state misplaced entry to SNAP in Might.
“This is going to come down to an affordability election, and that’s going to hurt 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 12 months, two-thirds of respondents mentioned they have been nervous 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 up to now 12 months. 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 problem 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 of toss-ups.
The Democratic Get together has the sting on healthcare points over Republicans, however about 3 in 10 voters reported that they don’t belief both celebration, famous Liz Hamel, a senior vp and the director of public opinion and survey analysis at KFF.
“It’s not an overwhelming advantage,” she mentioned.
Not Your Textbook Republican Governor
Lombardo’s marketing campaign has touted his help for a kids’s hospital set to be in-built Las Vegas; his consolidation of the state’s Medicaid program, ACA market, and public worker advantages program right into a single company; and the enlargement of the variety of neighborhood 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 standard Republican playbook. For instance, he mentioned in 2022 that he would oppose a nationwide abortion ban, and in 2023 he signed into regulation a Democratic-led invoice prohibiting state companies from cooperating with different states looking for to prosecute individuals for touring to Nevada to get an abortion.
The governor additionally signed payments into regulation in 2023 that prohibit insurance coverage firms from partaking in gender discrimination and require state correctional amenities to make sure better protections for transgender and nonbinary individuals, together with setting requirements for medical care and psychological well being therapy.
Extra just 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 12 months, he endorsed a proposed constitutional modification to ban transgender athletes from women’ and girls’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 Impartial, Lombardo mentioned he was shocked throughout his first time period as governor by how “complicated” and “encompassing” healthcare is, and by the “cost of it.”
“Government seems to complicate some of those bigger processes more often than not,” Lombardo mentioned, “but in this case, they’re instrumental in the success or failure of healthcare and how people suffer as a result of bad decisions.”
His opponent, Ford, started his political profession as a Nevada state senator and have become the state’s first Black lawyer common 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 resembling 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 at any time when he hears a reference to the “Big Beautiful Bill.”
“It hits me differently,” Ford mentioned.
His marketing campaign’s “Affordable Nevada” plan requires reducing prescription drug prices, boosting consciousness of the state’s public-option well being plans that debuted this 12 months, 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 seems like, if anything, the Trump administration’s approach is not going to help Republicans in the midterms,” Hamel mentioned. However, she added, “November is many months away. A lot of things could 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 a press release that he can be assembly with the president throughout his go to, however Politico reported they spoke solely by telephone. Damore mentioned he doesn’t assume it was an accident that Lombardo didn’t seem with the president publicly.
“Lombardo has done a nice job trying to thread the needle between himself and Trump,” he mentioned.
However Ford has a neater street forward in the case of campaigning for healthcare points, Damore mentioned.
“He just kind of has to say, ‘I’ll do better,’ and point the finger at Trump and say, ‘Where is Lombardo fighting this kind of stuff?’” Damore mentioned. “That’s a pretty easy campaign for him.”
Partisan Nevada voters are practically evenly break up between the 2 events, however the majority are registered as nonpartisans, most likely as a result of the state’s automated voter registration program makes “nonpartisan” the default possibility for residents who register on the Division of Motor Autos. As of final 12 months, voters can 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, house to Las Vegas and practically three-quarters of Nevada’s inhabitants, leans Democratic. The subsequent-largest county by inhabitants is Washoe County, which is house to Reno and is the solely 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 for the reason that covid pandemic.
“People are just kind of surly,” he mentioned. “They keep kind of ping-ponging back and forth between the parties. It doesn’t seem to change much.”
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.
“Sometimes the only way to get something done, to protect it, is to sue,” Cohen mentioned. “I think he’ll bring that background.”
Are you struggling to afford your medical insurance? Have you ever determined to forgo protection? Click on right here to contact KFF Well being Information and share your story.
