¶ Overview
In 2025, Lombardo supported Trump’s “One Big Beautiful Bill,” and its Medicaid work requirements, which is estimated to kick 17 million Americans off their health insurance, including nearly 12 million Americans who rely on Medicaid. Under the “One Big Beautiful Bill,” more than 100,000 Nevadans could lose their health insurance, and Nevada community health centers could be downsized.
Lombardo said “Nevadans should be excited about” the “One Big Beautiful Bill,” despite previously expressing concerns about the “detrimental” cuts to Medicaid it would cause. 67,888 Medicaid recipients in Nevada were expected to lose their coverage by 2034 under the bill.
Lombardo opposed Democrats' efforts to extend the enhanced Affordable Care Act premium tax credits that Nevadans relied on for affordable health insurance. Lombardo called for Democrats to pass a “clean C.R." to reopen the government without extending the subsidies that were set to expire at the end of 2025, and accused Democrats of using them as a “leverage point." 22 million Americans relied on the enhanced subsidies to afford health insurance, and 12.5 percent fewer Nevadans were enrolled in ACA plans after they expired.
¶ Lombardo Supported Stripping Health Insurance Away From Millions Of Americans Who Relied On Medicaid
¶ Lombardo Said “Nevadans Should Be Excited About” Trump’s “One Big Beautiful Bill” And Dismissed Concerns About Cuts To Medicaid
¶ Lombardo Said “Nevadans Should Be Excited About” The “One Big Beautiful Bill”
July 2025: Lombardo Dismissed Concerns About The “One Big Beautiful Bill” As “Bickering” “Talking Heads,” And Said “Nevadans Should Be Excited About The Potential Impacts” Of The Bill. According to Lombardo’s Twitter, “As beltway talking heads bicker over today’s budget bill, it’s important to remember that President Trump just delivered on his historic promise of No Tax on Tips or Overtime. That is a huge win for hardworking Nevadans! While my administration continues to assess this bill as it moves to get signed into law, Nevadans should be excited about the potential impacts of tax cuts, investments in small business and American manufacturing, and efforts to help secure our border.”
[Twitter, @JoeLombardoNV, 7/3/25]
¶ Lombardo Supported Medicaid Work Requirements In The "One Big Beautiful Bill" As "Stopgaps" Against Fraud
Lombardo Supported Medicaid Work Requirements In Trump’s “One Big Beautiful Bill” As “Stopgaps” Against Fraud In Medicaid And Medicare Systems, Which He Said Was “Proliferat[ing] Across The United States.” According to Lombardo in an interview with KTVN 2 News Nevada, “HOST: And recently, the legislature had an interim session and your, actually, new Nevada Health Authority gave a presentation on the impacts of the Big Beautiful Bill with Medicaid in this state. And there's not much that the state can do, I think they gave four options that the state has the ability to do with those federal guidelines. Kind of what does that look like for you with the communication with Stacey Weeks with the Nevada Health Authority and kind of looking at the future, because it seems like a lot of drastic changes could be coming to health care. LOMBARDO: Well, I think there's a lot of checks and balances being brought to health care. We've seen it proliferate across the United States. You see it in the news feeds, usually on a weekly basis, that fraud is being perpetrated against the Medicaid and the Medicare systems and even the state systems. And we have to ensure that we have stopgaps in there in support of that. And one of the big things we deal with in the Medicaid space is the work requirement that came out of the Big, Beautiful Bill and put upon the consumer of that benefit. And I support that. I support that. You know, any time that we can put eyes on and prevent fraud, which is a big number in government at both the federal and the state level, and the local level, because when fraud is being perpetrated and you have to dedicate funds associated with whatever system that is supporting, that means other systems that you want to support are suffering or you don't have the ability to do it.” [Joe Lombardo Interview - KTVN 2 News Nevada, 5/21/26] (VIDEO)
¶ Lombardo Claimed The “One Big Beautiful Bill” Did Not Make “Any Cuts In The Short Term” To Nevada’s Medicaid Budget
August 2025: Lombardo Dismissed Concerns About Medicaid Cuts From The “One Big Beautiful Bill,” Claiming The Bill Did Not “Direct Any Cuts In The Short Term” To Nevada’s Medicaid Budget. According to News 3 Las Vegas, “Governor Joe Lombardo spoke on how the One Big Beautiful Bill is not affecting Nevada Medicaid at this time. ‘The bill doesn't direct any cuts in the short term,’ he said.” [News 3 Las Vegas, 8/4/25]
¶ Lombardo Previously Expressed Concerns About Medicaid Cuts In The “One Big Beautiful Bill” But Admitted He Did Not Have A Plan To Address Them
¶ Lombardo Previously Stated Medicaid Cuts In The “One Big Beautiful Bill” Would Be “Detrimental For Nevada”
February 2025: Lombardo Previously Expressed Concerns About Medicaid Cuts In The “One Big Beautiful Bill,” Noting That Rolling Back Medicaid Expansion, Imposing Per-Capita Limits, And Lowering Matching Funds Would Be “Detrimental For Nevada.” According to The Nevada Independent, “The request came in the form of a letter Wednesday, outlining the Republican governor's concerns about a variety of cuts to the program proposed in a budget resolution passed by congressional Republicans on Tuesday. The letter warned that the cuts could spell financial trouble for the Silver State. ‘Nevada has demonstrated that federal investment in the state’s Medicaid program has improved both health outcomes and productivity, yet challenges remain,’ Lombardo wrote. ‘By leveraging federal funding the state has expanded access to school health services, lowered the uninsured rate, and made significant progress in enhancing behavioral health care for both children and adults.’ He noted that as one of the fastest-growing states in the country, Medicaid gives Nevada flexibility to adjust to demographic changes and ‘limitations on Medicaid funding would clearly hinder that ability.’ Of the proposals being weighed for cuts, Lombardo highlighted the following issues as ‘most detrimental for Nevada’: rolling back expanded Medicaid for low-income residents, imposing a per-capita limit on how much the federal government will pay for Medicaid and lowering the matching funds for hospital provider fees, which Nevada intends to use for overhauling the state’s behavioral health care system for children.” [Nevada Independent, 2/26/25]
¶ Lombardo Admitted He Did Not Have A Contingency Plan For Potential Medicaid Cuts Under The Bill
February 2025: Lombardo Said He Did Not Have A Contingency Plan For Potential Medicaid Cuts, Which He Admitted Would Be A “Detriment” To Individuals And Providers, And Compared The Cuts To “Godzilla” And “Like The Pickle’s Too Big For The Jar.” According to Lombardo in an interview with IndyTalks, “HOST: One in four Nevadans is on Medicaid, Governor. People may not know that 800,000 or so that that's a huge portion of the budget. And there is talk, serious talk from Washington about cutting those funds. That would be devastating, wouldn't it? LOMBARDO: Yeah, absolutely. I mean, to put it in context, Medicaid exclusive of Medicare, my bill with that particular department is 450 million a month. 450 million a month. So imagine the detriment it would occur to individuals and providers. You know, there is a significant number of doctors slash providers that rely on Medicaid to keep their doors open. And so those emergency plans that we discussed earlier have to be in place. HOST: How can you have contingency planning for that much money? LOMBARDO: You can’t. It's almost like the pickle’s too big for the jar, right? And Godzilla, how do you plan for Godzilla?” [Joe Lombardo Interview – IndyTalks, 2/11/25] (VIDEO)
¶ At Least 17 Million Americans Would Lose Health Insurance Under The “One Big Beautiful Bill” And Put Rural Hospitals At Risk Of Closure
¶ At Least 17 Million Americans Would Lose Insurance Under Trump’s Tax Plan
HEADLINE: "At Least 17 Million Americans Would Lose Insurance Under Trump Plan" [Washington Post, 7/1/25]
HEADLINE: “By The Numbers: Harmful Republican Megabill Favors The Wealthy And Leaves Millions Of Working Families Behind” [Center On Budget And Policy Priorities, 8/1/25]
The Congressional Budget Office Estimated That 11.8 Million People Would Become Uninsured As A Result Of The Medicaid Cuts In Republicans’ Reconciliation Bill. According to the Washington Post, "The bill, which narrowly passed the Senate on Tuesday and now heads back to the House, would effectively accomplish what Republicans have long failed to do: unwind many of the key components of the ACA, President Barack Obama’s signature domestic achievement, which dramatically increased the number of Americans with access to health insurance. To start, the Congressional Budget Office estimated that the Senate version of the bill would result in 11.8 million more uninsured in 2034, mostly because of Medicaid cuts, compared with 10.9 million if the House version became law." [Washington Post, 7/1/25]
The Bill’s $50 Billion In Rural Hospital Relief Funding Would Not Come Close To The Gap Created By Medicaid Cuts, With 300 Rural Hospitals At “Immediate Risk” Of Closure. According to the Center For American Progress, “The OBBBA includes $50 billion in relief funding for rural hospitals over a five-year period to help reduce the disastrous impacts of the bill’s roughly $1 trillion in Medicaid cuts. As of May 2025, there were approximately 2,086 rural hospitals receiving $12.2 billion a year in net revenue from Medicaid. At the median, rural hospitals’ revenue from Medicaid is $3.9 million a year. Rural hospitals have some of the lowest operating margins in the nation, especially compared with urban hospitals, meaning that any reductions in revenue could lead to closures. The average operating margin for rural hospitals was 3.1 percent in 2023, with 44 percent of rural hospitals operating with negative margins. As a result, more than 300 rural hospitals are currently at ‘immediate risk’ of closure, especially now that the OBBBA is projected to cut Medicaid spending by $1.02 trillion. The relief fund designed to blunt the negative impacts caused by the bill would not come close to filling that gap. If every rural hospital in the country received an even share of the $50 billion in relief support, it would amount to only $4.5 million every year for five years. At the close of those five years, that funding would disappear altogether.” [Center For American Progress, 7/3/25]
¶ Nevada Community Health Centers Said They Would Have To Downsize Under Medicaid Cuts
Nevada Community Health Centers Like Northern Nevada HOPES, Of Which 40 Percent Of Their Patients Were On Medicaid, Said They Would Have To Downsize Under The “One Big Beautiful Bill” Medicaid Cuts. According to News 3 Las Vegas, “The impacts will be felt most acutely, experts said, by community health centers, which serve significant numbers of patients on Medicaid. For example, Northern Nevada HOPES, which has 3 clinics in Reno, serves 22,000 people annually. 40% of their patients are on Medicaid, said CEO Sharon Chamberlain. ‘We will not be able to continue to operate the way that we do currently (if this bill passes). If those individuals lose Medicaid and end up on our sliding fee scale that's based on their income, we don't make enough to pay for the services that we offer. So we will definitely have to look at downsizing,’ she said.” [News 3 Las Vegas, 7/2/25]
¶ More Than 100,000 Nevadans Were Expected To Lose Health Care Coverage Under Trump’s “One Big Beautiful Bill”
Under The “One Big Beautiful Bill,” 106,788 Nevadans Were Expected To Lose Their Health Care By 2034, Including 38,900 ACA Enrollees And 67,888 Medicaid Recipients. According to the Joint Economic Committee Minority,
| District | State | Est. # Losing ACA Coverage | Est. # Losing Medicaid Coverage | Est. Total # Losing Insurance |
| NV-01 | Nevada | 9,000 | 19,916 | 28,916 |
| NV-02 | Nevada | 9,400 | 13,218 | 22,618 |
| NV-03 | Nevada | 13,400 | 13,214 | 26,614 |
| NV-04 | Nevada | 7,100 | 21,540 | 28,640 |
| All | Totals | 38,900 | 67,888 | 106,788 |
[Joint Economic Committee Minority, 6/25]
- The House GOP Budget Bill Was Estimated To Increase The Uninsured Population By 8.6 Million By 2034. According to CNN, “The Medicaid and Affordable Care Act provisions in the package could result in 8.6 million more people being uninsured in 2034, according to an early CBO estimate released by Democratic lawmakers. That number is expected to grow with the latest changes.” [CNN, 5/28/25]
- The House GOP Budget Bill Codified A Trump Administration Proposal That Restricted Access To The Affordable Care Act. According to CNN, “The bill also calls for codifying a Trump administration proposal that would make changes to the Affordable Care Act enrollment process, including shortening the open enrollment period and eliminating the ability of low-income Americans to sign up year-round.” [CNN, 5/28/25]
- New York Times Reported The $880 Billion In Cuts Required By The Republican Budget Proposal Would Have To Come From Medicaid, Medicare, Or CHIP. According to the New York Times, "The budget resolution itself is silent on whether Congress cuts Medicaid, which provides health coverage to 72 million poor and disabled Americans. But it instructs the House Energy and Commerce Committee, which has jurisdiction over the program, to cut spending by $880 billion over the next decade. If the committee can’t save at least that much, the entire effort could be imperiled because of the special process Congress is using to avoid a Senate filibuster. Ten other committees have their own instructions to follow, though none have been assigned with cutting nearly as much. It’s not so simple as finding the cuts elsewhere. The special process, known as budget reconciliation, means Republicans will have to find all $880 billion from within the Energy and Commerce Committee’s jurisdiction. That leaves them with fewer options than one might think. […] If Republicans want to avoid major cuts to Medicaid, the largest pot of available money is in the other big government health insurance program: Medicare. […] Even if the committee cuts everything that’s not health care to $0, it will still be more than $600 billion short. The committee could also save around $200 billion by eliminating the Children’s Health Insurance Program, but that option has not been raised by the budget committee or anyone in House leadership. […] Even if all of these cuts, revenues and rule cancellations from outside health care can pass muster, the committee will still be left with hundreds of billions of dollars to cut to hit its goal. Mathematically, the budget committee’s instructions mean the committee would need to make major cuts to either Medicare, Medicaid or both." [New York Times, 2/25/25]
¶ Lombardo Opposed Efforts To Extend The Enhanced Affordable Care Act Premium Tax Subsidies That Made Health Insurance Affordable For Nevadans
¶ Lombardo Accused Democrats Of Using Enhanced Affordable Care Act Subsidies As A “Leverage Point” And Called For Them To Reopen The Government
Lombardo Said Democrats Allowing The Government To Shut Down Over Expiring Enhanced Affordable Care Act Credits Was Turning “Good Policy” Into A “Leverage Point,” And Said Issues With The ACA Should Be Addressed Later In The Fiscal Year. According to Lombardo at Three Square Food Bank, “QUESTION: Do you have a position on the Democratic reasoning for maintaining or not voting for the—LOMBARDO: Well, obviously it’s, it’s through the ACA process. Right. And and, you know, unfortunately, instead of good policy it has become an, a leverage point. And and so that's the, the linchpin in that process. I think it could be better served as a normal practice in the time remaining in the, in the fiscal year to work through the ACA issues.” [Joe Lombardo - Three Square Food Bank, 11/3/25] (VIDEO)
Lombardo Called For “Democratic Senators To Make A Decision To Reopen The Government” And Pass A “Clean C.R.” According to Lombardo at Three Square Food Bank, “QUESTION: So we're here because of a government shutdown, right. And have you tried any lobbying on behalf of, you know—LOMBARDO: Absolutely, I'll cut you off on your question. Yes, we are in a government shutdown. I have talked to the federal government to let the, you know, we need to reopen. You know, we need a clean E.R.—C.R. presented and we need the Democratic senators to make a decision to reopen the government. And, you know, those conversations have been constant. You know what, I don't want to use the word constant. They have been frequent. And we're continuing, hopefully, to communicate our desires. We have expressed our desires as a state government and as the governor of the state of Nevada, and we need to figure that out sooner than later.” [Joe Lombardo - Three Square Food Bank, 11/3/25] (VIDEO)
¶ Democrats Refused To Pass A C.R. To Reopen The Government That Would Allow Enhanced ACA Tax Credits To Expire At The End Of 2025
Democrats Were Unwilling To Pass A “Clean” C.R. That Would Reopen The Government Without Extending The Enhanced Affordable Care Act Premium Tax Credits Set To Expire At The End Of 2025. According to ABC News, “The subsidies were part of the original Affordable Care Act passed during the Obama administration and were enhanced during the COVID-19 pandemic to increase the amount of financial assistance to those who were already eligible and to expand eligibility to more people. They are set to expire at the end of the year. [...] Democratic leaders have said they are not willing to vote to reopen the government unless Republicans negotiate on health care demands, while Republicans have signaled unwillingness to negotiate on health care policy unless the government is reopened -- an effective stalemate. ‘Republicans are saying that we should have what is referred to as a clean bill, just continue the government operations as they were, without extending these subsidies, and then once we've got that, then we can come back and we can talk about things like extending the subsidies,’ Buntin said. ‘Democrats are seen so far unwilling to agree to that, which I think represents a sort of breakdown in normal process.’” [ABC News, 10/11/25]
¶ 22 Million Americans Relied On The Enhanced ACA Subsidies To Afford Health Insurance, And 12.5 Percent Fewer Nevadans Were Enrolled In Affordable Care Act Plans After They Expired
Approximately 22 Million Americans Relied On ACA Premium Tax Credits To Afford Health Insurance. According to CNBC, "About 22 million Americans received premium subsidies, also known as premium tax credits, in 2025. Households can opt to receive the tax credit in one of two ways: As a lump sum during tax season or as an advanced payment. Under the latter option, by far the most popular, the federal government issues the tax credit directly to a consumer’s insurer, which then lowers the consumer’s out-of-pocket premium. Consumers receive those advanced ACA subsidies based on an estimated annual income they provide when signing up for insurance. They must reconcile those subsidies during tax season and repay any excess tax credits to the IRS." [CNBC, 1/6/26]
January 2026: 12.5 Percent Fewer Nevadans Were Enrolled In Affordable Care Act Plans After The Expiring Federal Tax Subsidies Caused Premiums To Increase By An Average Of $82 From 2025. According to the Nevada Independent, “Data from Nevada Health Link shows that the average net premiums for subsidized enrollees increased by $82 from 2025 to 2026. While state officials said they cannot point to a single cause, the enrollment declines come as costs have increased. ‘The biggest change within the ACA over the last year has been the expiration of the enhanced federal tax subsidies that were available,’ said Jennifer Krupp of Nevada Health Link, noting that some consumers are now facing higher out-of-pocket costs. For 2026, experts say rising premiums caused an initial decline during open enrollment, followed by a second drop after bills began to hit pocketbooks. After the 2026 open enrollment period, enrollment dropped by 12.5 percent. That's more than the 5.7 drop in the same few months following the 2025 open enrollment period.” [Nevada Independent, 7/11/26]