Nevada Voters Put Health Care Affordability at Center Stage

For Steven Cohen, one question will help determine how he votes in Nevada’s governor’s race this fall: which candidate is more likely to keep him from losing Medicaid coverage. Cohen, a 38-year-old Las Vegas resident with autism, is enrolled in both Medicaid and Medicare. He said he worries that he could be cut off from Medicaid when work requirements and more frequent eligibility checks begin in January under congressional Republicans’ One Big Beautiful Bill Act.

Cohen said the issue matters to him because his medical visits add up quickly. He receives care from providers, including for mental health, and often goes more than once a month. “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,” he said.

His concern lands in the middle of a closely watched race between Republican Gov. Joe Lombardo and Democratic state Attorney General Aaron Ford. The Nevada contest is one of 39 gubernatorial elections to be decided in November. Lombardo has President Donald Trump’s endorsement, but healthcare policy changes tied to the Trump administration are shaping the race in ways that may not help him with voters such as Cohen in this swing state.

Those changes include Medicaid funding cuts that are expected to put pressure on state budgets, along with new work and eligibility rules for Medicaid and for the Supplemental Nutrition Assistance Program, or SNAP, which helps low-income families buy food. The changes are expected to increase the number of uninsured people nationwide by an estimated 7.5 million in 2034 and reduce SNAP participation by 2.4 million people in an average month from 2025 to 2034.

People across the country are also feeling higher health insurance premiums after Congress let enhanced Affordable Care Act subsidies expire at the end of last year. Many people who buy coverage on ACA marketplaces have chosen cheaper plans with less coverage, while others have gone without insurance entirely. In Nevada, those shifts could have an outsized effect because tourism, hospitality, and gaming are central to the state’s economy.

Nearly 300,000 Nevadans are self-employed, independent contractors, or freelancers and do not have employer-sponsored health benefits. Many of them buy insurance through the state’s ACA health exchange, which saw enrollment fall 5.5% this year after a record 110,000 people signed up for 2025. Even before the latest federal changes, Nevada’s uninsured rate was 11.4% in 2024, the fourth-highest in the country.

A state Medicaid official told lawmakers in May that about 70,000 Nevadans could lose coverage under the new rules. Around 28,000 people in the state lost access to SNAP in May. University of Nevada-Las Vegas political science professor David Damore said the issue could dominate the election. “This is going to come down to an affordability election, and that’s going to hurt the Republicans,” he said.

KFF polling this year found that two-thirds of respondents were worried about affording healthcare, more than said the same about food and groceries, housing, or gas. More than half said their healthcare costs had gone up in the past year. KFF is a health information nonprofit that includes KFF Health News. Most respondents said healthcare costs would affect how they vote in November, and the issue was especially important among Democrats and independents.

Other competitive governor’s races are underway in Arizona, Georgia, Iowa, Michigan, and Wisconsin, and all are considered toss-ups. Liz Hamel, senior vice president and director of public opinion and survey research at KFF, said Democrats have an advantage on healthcare, but not an overwhelming one. About 3 in 10 voters said they do not trust either party on the issue.

Lombardo’s campaign has highlighted several healthcare actions during his first term. It has pointed to his support for a children’s hospital planned for Las Vegas, his consolidation of the state’s Medicaid program, ACA marketplace, and public employee benefits program into a single agency, and the expansion of community behavioral health centers in Nevada. Before becoming governor and defeating Democrat Steve Sisolak in 2022, Lombardo served eight years as sheriff in Clark County. Before that, he spent 26 years with the Las Vegas Metropolitan Police Department.

On healthcare, Lombardo has taken some positions that differ from the usual Republican line. In 2022, he said he would oppose a national abortion ban. In 2023, he signed a Democratic-led bill that bars state agencies from helping other states prosecute people who travel to Nevada for an abortion. He also signed bills prohibiting insurance companies from engaging in gender discrimination and requiring state correctional facilities to provide stronger protections for transgender and nonbinary people, including standards for medical care and mental health treatment.

More recently, however, Lombardo has moved closer to the Make America Great Again movement. In 2025, he vetoed a bill that would have protected clinicians who provide gender-affirming care. This year, he endorsed a proposed constitutional amendment to ban transgender athletes from girls’ and women’s sports. His campaign declined to make him available for an interview for this report.

In a March interview with Jon Ralston, chief executive of The Nevada Independent, Lombardo said he had been surprised in his first term by how “complicated” and “encompassing” healthcare is, and by its cost. He said government can make big systems more difficult to manage, but in healthcare, government is often central to whether people succeed or suffer because of policy decisions.

Ford, meanwhile, brings a different personal history to the campaign. He began his political career as a Nevada state senator and became the state’s first Black attorney general in 2019. He has spoken about raising his eldest son alone while attending Texas A&M University and relying on public benefits, including Section 8 housing, Medicaid, food stamps, and the Women, Infants and Children program. Ford said those experiences shape how he thinks about the federal law that Republicans call the “Big Beautiful Bill.” “It hits me differently,” he said.

His campaign’s “Affordable Nevada” plan focuses on lowering prescription drug costs, increasing awareness of the state’s public-option health plans that debuted this year, and canceling medical debt. Damore said Ford has a simpler message on healthcare because he can promise to do better and point to Trump and Lombardo.

The broader political backdrop may also help explain why affordability is resonating. In the KFF poll, most voters said they have little or no confidence in how the Trump administration is handling the cost of living. Hamel said that could be a liability for Republicans in the midterms, though she noted that many months remain before November and circumstances could still shift.

Lombardo appears to be keeping some distance from Trump as gas prices and affordability concerns rise. When Trump visited Las Vegas in April, Lombardo did not attend. He later said he would meet with the president during the visit, but Politico reported that they spoke only by phone. Damore said Lombardo seemed to be trying to balance his relationship with Trump.

Nevada’s political map adds another layer. Party registration is nearly even, but most voters are registered as nonpartisans, in part because automatic voter registration at the Department of Motor Vehicles defaults people to nonpartisan status. Since last year, people registering at the DMV must later fill out party paperwork sent by their county election office. Clark County, home to Las Vegas and nearly three-quarters of the state’s population, leans Democratic. Washoe County, which includes Reno, is the only swing county. The rest of the state is rural and reliably Republican.

Still, years of inflation and higher costs since the covid pandemic have left many voters frustrated. “People are just kind of surly,” Damore said. “They keep kind of ping-ponging back and forth between the parties. It doesn’t seem to change much.” Cohen said he plans to vote for Ford, whom he sees as most willing to protect Medicaid enrollees. “Sometimes the only way to get something done, to protect it, is to sue,” he said. “I think he’ll bring that background.”