2026年6月22日 美国东部时间早上5:00 / KFF健康新闻
有一个议题将决定史蒂文·科恩今年秋季在内华达州州长选举中的投票：哪位候选人能最好地保护他免于被取消医疗补助计划资格。
科恩是一名38岁的拉斯维加斯居民，患有自闭症，同时享受医疗补助计划和医疗保险双重参保待遇。他表示，自己非常担心根据国会共和党人的《一项宏伟法案》，工作要求和更频繁的资格审查将于明年1月生效后，他可能会失去医疗补助覆盖。
“当你每月去看一两次医疗服务提供者，尤其是心理健康方面的医生，或者有时一周要看几次，这些自付费用很快就会累积起来，”科恩说道。
共和党州长乔·隆巴多正在内华达州进行连任竞选，这场竞争十分胶着，他的对手是民主党州总检察长亚伦·福特。11月将举行美国39场州长选举，这场是其中之一。隆巴多获得了特朗普总统的背书，但特朗普政府做出的医疗保健政策调整，正在让这位摇摆州的选民（比如科恩）倒向对他不利的一方。
这些调整包括预计将给州预算带来压力的医疗补助计划资金削减，以及针对医疗补助计划和为低收入家庭提供食品援助的补充营养援助计划的新工作要求和资格审查规则。预计到2034年，这些调整将使全国 uninsured人数增加约750万，并且在2025年至2034年的平均月度参保人数中，补充营养援助计划的受助人数将减少240万。
自国会于去年年底终止了负担得起的医疗法案的额外补贴以来，全美民众都在承受医疗保险保费上涨带来的压力。许多在奥巴马医改交易所购买健康保险的人选择了保额更低的廉价计划，或者干脆不再投保。
这些变化在内华达州将产生重大影响——该州的经济支柱是旅游业、酒店业和博彩业。内华达州近30万人为个体经营者、独立承包商或自由职业者，没有雇主提供的健康保险福利。许多人通过该州的奥巴马医改健康交易所购买保险，而在2025年创纪录的11万人参保后，今年的参保人数下降了5.5%。
根据2024年的数据，即使在联邦政策调整之前，内华达州11.4%的无保险率就已经是全美第四高。该州一名医疗补助官员在5月份告诉议员，根据新规定，预计有7万名内华达州居民可能会失去医疗补助覆盖。该州约2.8万人在5月失去了补充营养援助计划的资格。
“这场选举归根结底是关乎负担能力的选举，这将对共和党不利，”内华达大学拉斯维加斯分校政治学系教授大卫·达莫尔说道。
在今年KFF的一项全国性民调中，三分之二的受访者表示他们担心负担得起医疗保健，这一比例高于担心食品杂货、住房或汽油价格的受访者比例。超过一半的受访者表示，过去一年他们的医疗成本有所上涨。KFF是一家健康信息非营利组织，旗下包括KFF健康新闻。
尽管大多数受访者表示医疗保健成本将影响他们11月的投票选择，但这一议题在民主党和无党派选民中更为紧迫。
亚利桑那州、佐治亚州、爱荷华州、密歇根州和威斯康星州也正在进行竞争激烈的州长选举，所有这些竞选都被视为势均力敌。
KFF高级副总裁兼民意调查与调研研究主任莉兹·哈梅尔指出，民主党在医疗保健议题上比共和党更具优势，但约十分之三的选民表示他们不信任任何一个政党。
“这算不上压倒性的优势，”她说道。
并非你印象中的共和党州长
隆巴多的竞选团队一直在宣传他对拉斯维加斯一家即将建成的儿童医院的支持；他将该州的医疗补助计划、奥巴马医改交易所和公共雇员福利计划整合为一个单一机构；以及在他的任期内扩大该州社区行为健康中心的数量。
在2022年竞选州长并击败民主党人史蒂夫·西萨克之前，隆巴多曾在内华达州克拉克郡担任了八年警长。在此之前，他在拉斯维加斯大都会警察局工作了26年。
隆巴多在第一任期内采取的医疗保健立场与典型的共和党套路有所不同。例如，他在2022年表示将反对全国性的堕胎禁令，并在2023年签署了一项民主党提出的法案，禁止州机构配合其他州起诉前往内华达州堕胎的人。
这位州长还在2023年签署了多项法案，禁止保险公司进行性别歧视，并要求州监狱系统为跨性别和非二元性别者提供更多保护，包括制定医疗护理和心理健康治疗的标准。
最近，隆巴多采取了更符合“让美国再次伟大”运动的行动。2025年，他否决了一项本应为提供性别确认护理的临床医生提供保护的法案。今年，他背书了一项拟议的宪法修正案，禁止跨性别运动员参加女子和女子组体育赛事。
隆巴多的竞选团队拒绝让州长接受本次报道的采访。在3月份接受非营利新闻机构《内华达独立报》首席执行官乔恩·拉尔森采访时，隆巴多表示，他在担任州长的第一个任期内，对医疗保健的“复杂性”和“覆盖面”以及其“成本”感到惊讶。
“政府似乎往往会让一些更大的流程变得更复杂，”隆巴多说，“但在这种情况下，政府对医疗保健的成败至关重要，而糟糕的决策会让人们受苦。”
他的对手福特的政治生涯始于内华达州州参议员，并于2019年成为该州首位黑人总检察长。
福特谈到了自己如何在就读德克萨斯农工大学期间独自抚养长子，并表示他依靠第8条住房补贴、医疗补助、食品券以及妇女、婴儿和儿童计划等公共福利来抚养孩子。
他说，正因有过这些经历，每当听到有人提及“宏伟法案”时，他就会想到那些预计将失去医疗补助覆盖的内华达州居民。
“这对我来说意义不同，”福特说道。
他的竞选团队提出的“负担得起的内华达”计划呼吁降低处方药成本、提高对今年首次推出的州公共选择健康计划的认识，并取消医疗债务。
一场对特朗普的公投？
在接受KFF民调的大多数选民表示，他们对特朗普政府解决生活成本问题的方式几乎没有或完全没有信心。
“看起来，即便有变化，特朗普政府的做法也不会在中期选举中帮助共和党，”哈梅尔说道。但她补充道：“11月还有好几个月，很多事情都可能改变。”
在汽油价格飙升和更广泛的负担能力问题背景下，隆巴多似乎正在与总统保持距离。
特朗普4月份访问拉斯维加斯时，隆巴多并未出席活动。这位州长后来发表声明称，他将在特朗普访问期间与总统会面，但据《政客》报道，两人仅通过电话交谈。达莫尔表示，隆巴多没有公开与总统同框，这并非偶然。
“隆巴多做得很好，试图在自己和特朗普之间找到平衡，”他说道。
但达莫尔表示，福特在竞选医疗保健议题时道路更顺畅。
“他只需要说‘我会做得更好’，并指责特朗普，说‘隆巴多在哪里对抗这类政策？’”达莫尔说道，“对他来说，这是一场相当轻松的竞选。”
内华达州的党派选民几乎在两党之间平分秋色，但大多数选民登记为无党派，这可能是因为该州的自动选民登记计划让在机动车管理局登记的居民默认选择“无党派”。截至去年，选民无法在机动车管理局选择政党，而是需要在登记后填写所在郡选举办公室邮寄的表格。
克拉克郡是拉斯维加斯的所在地，也是内华达州近四分之三人口的家园，该郡倾向于民主党。按人口计算的第二大郡是瓦肖郡，这里是里诺的所在地，也是该州唯一的摇摆郡。该州其他地区均为农村，一贯投票给共和党。
但达莫尔表示，自新冠疫情以来，经历了多年的通货膨胀和成本上涨，内华达州的选民已经感到疲惫。
“人们只是有点脾气暴躁，”他说，“他们在两党之间来回摇摆，似乎没什么变化。”
拉斯维加斯选民科恩是一名无党派登记选民。他表示，他计划投票给福特，因为这位候选人似乎最愿意努力保护医疗补助计划的参保者。
“有时候，要做成某件事、保护某样东西，唯一的办法就是提起诉讼，”科恩说，“我认为他会具备这种背景。”
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Affordable healthcare emerges as a voter priority in purple Nevada
June 22, 2026 5:00 AM EDT / KFF Health News
One issue will decide Steven Cohen’s vote for Nevada governor this fall: Which candidate can best protect him from getting kicked off Medicaid?
Cohen is a 38-year-old Las Vegas resident with autism and has dual enrollment in Medicaid and Medicare. He said he’s very concerned that he could lose his Medicaid coverage once work requirements and more frequent eligibility checks take effect in January, under congressional Republicans’ One Big Beautiful Bill 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 said.
Republican Gov. Joe Lombardo is running for reelection in a tight race against Democratic state Attorney General Aaron Ford in one of 39 U.S. gubernatorial elections to be decided in November. Lombardo has President Trump’s endorsement, but healthcare policy changes made by the Trump administration are working against him with voters like Cohen in the swing state.
Those changes include Medicaid funding cuts that are expected to strain state budgets, along with new work requirement and eligibility rules for Medicaid and the Supplemental Nutrition Assistance Program, which provides food assistance for low-income families. The changes are expected to increase the number of people without health insurance nationwide by an estimated 7.5 million in 2034 and decrease the number of people who receive SNAP by 2.4 million people in an average month from 2025 to 2034.
People across the U.S. have also been feeling the pinch of rising health insurance premiums since Congress allowed enhanced Affordable Care Act subsidies to expire at the end of last year. Many who purchase health plans on the ACA marketplace have chosen less expensive plans with less coverage or are going without insurance altogether.
These changes will have a significant impact in Nevada, where tourism, hospitality, and gaming are cornerstones of the state’s economy. Nearly 300,000 people in Nevada are self-employed, independent contractors, or freelancers without employer-sponsored health insurance benefits. Many purchase insurance through the state’s ACA health exchange, which saw a 5.5% decrease in enrollment this year after a record 110,000 people signed up for 2025.
Even before the federal changes, Nevada’s 11.4% uninsurance rate was already the fourth-highest in the nation, according to data from 2024. A state Medicaid official told lawmakers in May that an estimated 70,000 Nevadans could lose their Medicaid coverage under the new rules. Around 28,000 people in the state lost access to SNAP in May.
“This is going to come down to an affordability election, and that’s going to hurt the Republicans,” said David Damore, a professor in the political science department at the University of Nevada-Las Vegas.
In a national KFF poll this year, two-thirds of respondents said they were worried about affording healthcare, more than the share who said the same about food and groceries, housing, or gas. And more than half said their healthcare costs had increased in the past year. KFF is a health information nonprofit that includes KFF Health News.
While most respondents said that healthcare costs will influence whom they vote for in November, the issue was more pressing among Democrats and independents.
Competitive gubernatorial races are also underway in Arizona, Georgia, Iowa, Michigan, and Wisconsin, with all those races considered toss-ups.
The Democratic Party has the edge on healthcare issues over Republicans, but about 3 in 10 voters reported that they don’t trust either party, noted Liz Hamel, a senior vice president and the director of public opinion and survey research at KFF.
“It’s not an overwhelming advantage,” she said.
Not your textbook Republican governor
Lombardo’s campaign has touted his support for a children’s hospital set to be built in 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 the number of community behavioral health centers in the state during his term.
Before running for governor and unseating Democrat Steve Sisolak in 2022, Lombardo served eight years as sheriff in Nevada’s Clark County. Before that he spent 26 years with the Las Vegas Metropolitan Police Department.
Lombardo has taken healthcare stances in his first term that diverge from the typical Republican playbook. For example, he said in 2022 that he would oppose a national abortion ban, and in 2023 he signed into law a Democratic-led bill prohibiting state agencies from cooperating with other states seeking to prosecute people for traveling to Nevada to get an abortion.
The governor also signed bills into law in 2023 that prohibit insurance companies from engaging in gender discrimination and require state correctional facilities to ensure greater protections for transgender and nonbinary people, including setting standards for medical care and mental health treatment.
More recently, Lombardo has taken actions more aligned with the Make America Great Again movement. In 2025, he vetoed a bill that would have created protections for clinicians who provide gender-affirming care. This year, he endorsed a proposed constitutional amendment to ban transgender athletes from girls’ and women’s sports.
Lombardo’s campaign declined to make the governor available for an interview for this report. In a March interview with Jon Ralston, CEO of the nonprofit news outlet The Nevada Independent, Lombardo said he was surprised during his first term 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 said, “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, began his political career as a Nevada state senator and became the state’s first Black attorney general in 2019.
Ford has talked about how he raised his eldest son on his own while attending Texas A&M University. He said he relied on public benefits such as Section 8 housing, Medicaid, food stamps, and the Women, Infants and Children program to provide for them.
He said because of those experiences, his thoughts go to the Nevadans expected to lose Medicaid coverage whenever he hears a reference to the “Big Beautiful Bill.”
“It hits me differently,” Ford said.
His campaign’s “Affordable Nevada” plan calls for lowering prescription drug costs, boosting awareness of the state’s public-option health plans that debuted this year, and canceling medical debt.
A referendum on Trump?
Most voters who responded to KFF’s poll said they have little or no confidence in how the Trump administration is addressing the cost of living.
“It seems like, if anything, the Trump administration’s approach is not going to help Republicans in the midterms,” Hamel said. But, she added, “November is many months away. A lot of things could change.”
Lombardo appears to be distancing himself from the president amid soaring gas prices and broader affordability issues.
When Trump visited Las Vegas in April, Lombardo didn’t attend the event. The governor later issued a statement that he would be meeting with the president during his visit, but Politico reported they spoke only by phone. Damore said he doesn’t think it was an accident that Lombardo didn’t appear with the president publicly.
“Lombardo has done a nice job trying to thread the needle between himself and Trump,” he said.
But Ford has an easier road ahead when it comes to campaigning for healthcare issues, Damore said.
“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 said. “That’s a pretty easy campaign for him.”
Partisan Nevada voters are nearly evenly split between the two parties, but the majority are registered as nonpartisans, probably because the state’s automatic voter registration program makes “nonpartisan” the default option for residents who register at the Department of Motor Vehicles. As of last year, voters can no longer choose a party at the DMV, instead needing to fill out paperwork their county election office mails after they register.
Clark County, home to Las Vegas and nearly three-quarters of Nevada’s population, leans Democratic. The next-largest county by population is Washoe County, which is home to Reno and is the only swing county in the state. The rest of the state is rural and consistently votes Republican.
But voters in Nevada are fatigued, Damore said, after years of inflation and rising costs since the COVID-19 pandemic.
“People are just kind of surly,” he said. “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 said he plans to vote for Ford because he is the candidate who seems most willing to work to protect Medicaid enrollees.
“Sometimes the only way to get something done, to protect it, is to sue,” Cohen said. “I think he’ll bring that background.”
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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
