Many analyses have been published to parse the effects of the Big Ugly Bill on Medicaid. A number of them differ due to the fact that they are all projections and are based on various assumptions. Also because they were prepared at different times and the text in HR1 kept changing to the very end. In this blog, we have attempted to assemble the most recent and authoritative sources.
BACKGROUND OF MEDICAID
What is Medicaid and who are the recipients? (1)
State & Federal taxpayer-funded health insurance
Covers a core set of benefits for recipients at no cost
Covers about 1 in 4 Nevadans; nearly half are children
Payer of last resort, making up about a quarter of Nevada’s insurance market
Largest source of federal funds for health care in the State (60/40)
800,000 Average number of people in Nevada covered
22% growth pre-COVID
54% Percentage of births covered by Nevada Medicaid; 1 in 2 births
75% Recipients served by Medicaid Managed Care Plans
40% Recipients who are children or youth (0-18)
11% Dually eligible for Medicare & Medicaid (85,897 individuals)
78% Recipients who live in Clark County
66% Percentage of adults enrolled in Medicaid who are employed
71% Nevadans enrolled in Medicaid who are people of color
57% Number of nursing facility residents covered by Medicaid
(1) Sources – State Legislature
https://www.leg.state.nv.us/Session/83rd2025/Exhibits/Assembly/HHS/AHHS70C.pdf
HR1 EFFECTS ON INDIVIDUALS
How many people will lose Medicaid coverage nationally? In Nevada? In Congressional District 4? (2) and (3)
Nationally
8,689,000
That translates into one in 10 people currently enrolled in the Medicaid program nationwide losing their coverage.
Nevada
116,000
Out of 787,384 statewide which is approximately15.6%
Clark County alone currently has 623,739 Medicaid recipients
Congressional District 4
30,000
Also about 15.6% (of approximately 192,000 recipients, calculated)
(2) Source – Nevada Office of Analytics
(3) Source – Manatt Health
However, there are other estimates that differ such as this one cited in the Washington Post on July 10 although the CBO letter dates from a month before the signing of the bill:
“Trump displays magical thinking. How can he enact the biggest spending cut in history and no one feel it? And, contrary to his claim that ‘Medicaid is left alone,’ the nonpartisan Congressional Budget Office estimated that new work requirements and other changes in the health care program for the poor will cause 7.8 million people to lose their coverage. CBO added that changes in the Affordable Care Act and a cutoff of aid to undocumented immigrants will mean a total of 11.8 million people will lose their health coverage under the law.” (4)
(4) Sources
https://www.washingtonpost.com/politics/2025/07/10/trump-democrats-tax-spending-bill-fact-checker
https://www.cbo.gov/system/files/2025-06/Wyden-Pallone-Neal_Letter_6-4-25.pdf
HR1 EFFECTS ON FINANCING
How much money is being taken away from Medicaid nationally? In Nevada? In CD4? (3)
Nationally
-$1,248,773,000,000 ($1.2 trillion)
Nevada
-$12,328,000 ($12.3 million)
CD4
The cited analysis does not include the specific amounts of the overall financing effects by Congressional District. However a prorated calculation based the changes in the number of recipients implies a reduction of about $3 million.
HR1 IMPACTS ON HOSPITALS
What are the impacts on hospitals’ Medicaid funding nationally? In Nevada? In CD4? (3)
These impacts will affect many of the rural hospitals like Mesa View.
Nationally
-$664,954,000 ($665 million)
Nevada
-$6,881,000 ($6.9 million)
CD4
-$2,874,000 ($2.9 million)
FURTHER INFORMATION
There is also a very detailed breakdown of the Medicaid cuts in this article from the NY Times:
https://www.nytimes.com/interactive/2025/06/30/upshot/senate-republican-megabill.html