Thirty-four hospitals across 13 Nevada counties are bracing for nearly $232 million in losses as federal Medicaid reductions take effect under the One Big Beautiful Bill Act. The cuts follow the disenrollment of approximately 115,000 Nevadans from the state’s Medicaid program, a move Republicans say is aimed at reining in decades of explosive entitlement growth.
The sweeping legislation, passed by Senate Republicans, includes new eligibility rules such as a strict work requirement and bars illegal immigrants from receiving Medicaid, shifting a significant number of non-disabled, low-income adults off coverage. Nationally, the law is expected to cut $1 trillion in Medicaid spending between 2025 and 2034.
In Nevada, the hardest-hit facility is University Medical Center in Las Vegas, facing a projected revenue loss of more than $45 million. Every affected county will lose at least $250,000. “The cuts are pretty significant, especially looking at rural hospitals,” said Darbin Wofford of the Washington-based research group Third Way. “It’s the largest Medicaid cut in history.”
Democrats in Nevada are sharply criticizing the move. Sen. Catherine Cortez Masto called it a blow to working families and accused Republicans of gutting healthcare to benefit the wealthy. But supporters of the bill, including U.S. Rep. Mark Amodei (R-NV), defended the legislation as a long-overdue correction to a ballooning federal program that cost $870 billion in 2023 alone.
Governor Joe Lombardo, a Republican, previously praised Medicaid expansion’s benefits but has remained silent since the law’s passage. His office has yet to issue a plan to address the fallout.
Wofford warned that the consequences could be widespread. Hospitals still must treat the uninsured, often through emergency rooms, but now without reimbursement. “That care the hospital provides will go uncompensated,” Wofford explained, “and the hospital ultimately will have to take that loss.”
To compensate, hospitals may raise premiums on privately insured patients, further straining the healthcare system. With Nevada’s Medicaid covering about 800,000 people prior to the cuts, a 14 percent disenrollment will have ripple effects across the state’s budget, forcing difficult choices like service cuts, tax hikes, or reductions in other key areas like education and infrastructure.
