¶ Overview
In 2010, as general counsel to Nevada Governor Jim Gibbons, Guzmán Fralick called for Attorney General Catherine Cortez Masto to join 14 other states’ attorneys general in suing the Obama administration to overturn the Affordable Care Act. Guzmán Fralick said she thought the arguments against the Affordable Care Act were “sufficient to give basis for a lawsuit” and was not “frivolous.” More than 104,000 Nevadans were enrolled in Affordable Care Act marketplace plans in 2026.
In 2026, Trump’s “One Big Beautiful Bill” made drastic changes to the Affordable Care Act to fund tax cuts for the wealthy, including allowing premium tax credit subsidies to expire which was expected to cause 4.2 million enrollees to become uninsured. It also made changes that would increase out-of-pocket expenses, make it more difficult for enrollees to remain eligible, and cost states more than $7 million to implement. More than 110,000 were expected to lose health insurance by 2034 due to the bill.
¶ Guzmán Fralick Supported Overturning The Affordable Care Act, Which Trump’s “One Big Beautiful Bill” Later Dismantled And Stripped Health Care From Nevadans
¶ Guzmán Fralick Called For The Nevada Attorney General To Join A Lawsuit Against The Affordable Care Act In 2010, Which Would Have Hindered More Than 104,000 Nevadans Who Relied On ACA Plans In 2026
2010: As Nevada Governor Jim Gibbons’ General Counsel, Guzmán Fralick Called For Attorney General Catherine Cortez Masto To Join A Lawsuit Against The Affordable Care Act. According to the Reno Gazette Journal, “As the U.S. Senate began debating changes to the health care reform bill signed into law by President Barack Obama on Tuesday, two of Nevada's leading Republicans pressed the state's Democratic attorney general to consider joining other states in a lawsuit to scuttle the new legislation. [...] Gibbons repeatedly has threatened to sue the federal government if the health care reform bill was signed by the president, but state law requires the attorney general to file any lawsuit on behalf of the state. To that end, his general counsel Adriana Fralick penned a letter to Masto asking her to join the multistate lawsuit. 'They had asked for the law and supporting arguments, but at this point, I think the lawsuit filed by the other 14 states is sufficient to give a basis for a lawsuit,' Fralick said. 'I don't think it's frivolous. I think they actually did their homework.' Gibbons insists it's unconstitutional for the federal government to require individuals to purchase health insurance or any other product. 'The moment the president signed that bill, every Nevadan lost their freedom of choice,' said Gibbons' spokesman, Dan Burns.” [Reno Gazette Journal, 3/24/10]
- Guzmán Fralick Said She Thought The Lawsuit Against The Affordable Care Act Filed In 14 Other States Was “Sufficient To Give Basis For A Lawsuit” And Was Not “Frivolous.” According to the Reno Gazette Journal, “To that end, his general counsel Adriana Fralick penned a letter to Masto asking her to join the multistate lawsuit. 'They had asked for the law and supporting arguments, but at this point, I think the lawsuit filed by the other 14 states is sufficient to give a basis for a lawsuit,' Fralick said. 'I don't think it's frivolous. I think they actually did their homework.’” [Reno Gazette Journal, 3/24/10]
¶ 2026: There Were 104,286 Nevadans Enrolled In An Affordable Care Act Marketplace Plan
As Of 2026, There Were 104,286 Individuals Enrolled In An Affordable Care Act Marketplace Plan In Nevada. According to KFF, in 2026, there were 104,286 individuals enrolled in Affordable Care Act marketplace plans in Nevada.
[KFF, Accessed 5/11/26]
¶ 2026: Trump’s “One Big Beautiful Bill” Allowed Affordable Care Act Tax Credits To Expire And Made Healthcare Cuts To Fund Tax Cuts For The Wealthy
¶ The “One Big Beautiful Bill” Allowed ACA Premium Tax Credit Subsidies To Expire Which Was Expected To Cause 4.2 Million Enrollees To Become Uninsured
Trump’s “One Big Beautiful Bill” Made Changes To The Affordable Care Act Marketplace That Impacted Coverage And Affordability. According to the American Medical Association, “On June 25, 2025, the Centers for Medicare & Medicaid Services (CMS) finalized its ACA marketplace integrity rule (CMS Final Rule) that makes several significant changes to marketplace eligibility and enrollment. On July 4, 2025, the One Big Beautiful Bill Act (OBBBA; Public Law 119-21) was signed into law. This legislation includes several policy and operational changes to the ACA marketplace that will further impact coverage and affordability in 2026 and beyond.” [American Medical Association, Accessed 5/12/26]
The “One Big Beautiful Bill” Did Not Extend The Affordable Care Act’s Enhanced Premium Tax Credit Subsidies That Capped Premiums At 8.5 Percent Of Income. According to the American Medical Association, “The OBBBA did not extend the enhanced premium tax credit (EPTC) subsidies that have significantly improved the affordability of ACA marketplace plans. Since 2021, the more generous subsidies have increased tax credits for people with incomes below 400 percent of the Federal Poverty Level (FPL), allowed those above 400 percent FPL to qualify for credits, and capped premiums at 8.5 percent of income. As a result, marketplace enrollment has risen to a record high of more than 24 million people.” [American Medical Association, Accessed 5/12/26]
- The Congressional Budget Office Estimated 4.2 Million ACA Enrollees Would Become Uninsured Due To Significantly Higher Premiums From The Expiring Tax Credit Subsidies. According to the American Medical Association, “Failure to extend the enhanced subsidies by the end of this year will lead to significantly higher premiums for all marketplace enrollees, many of whom may opt out of coverage. The Congressional Budget Office (CBO) estimates that 4.2 million enrollees will become uninsured if the EPTCs are allowed to expire.” [American Medical Association, Accessed 5/12/26]
¶ The “One Big Beautiful Bill” Changed ACA Enrollment Rules Which Were Expected To Cost States More Than $7 Million To Implement And Make It More Difficult For Enrollees To Remain Eligible
The “One Big Beautiful Bill” Shortened The Federally-Facilitated Affordable Care Act Marketplace Open Enrollment Period From November 1 Through January 15 To November 1 Through December 15. According to the American Medical Association, “In recent years, open enrollment for ACA marketplaces began November 1 and ended January 15. CMS’ final rule shortened the annual open enrollment period (OEP) for all individual market exchanges and delayed implementation for one year. Leading up to plan year 2027, CMS will run open enrollment for the federally-facilitated exchange from November 1 to December 15.” [American Medical Association, Accessed 5/12/26]
- The Bill Required State Marketplaces’ Open Enrollment To Begin By November 1, End By December 31, And Not Exceed Nine Weeks, Which Was Estimated To Cost States More Than $7 Million To Implement. According to the American Medical Association, “State-based marketplaces will be able to set their own open enrollment dates but must begin an OEP by November 1 and end it no later than December 31 while not exceeding 9 weeks. CMS estimates it will cost state-based exchanges more than $7 million to implement the shortened open enrollment period.” [American Medical Association, Accessed 5/12/26]
The “One Big Beautiful Bill” Eliminated The Ability To Automatically Reenroll In Affordable Care Act Marketplace Plans, Which More Than Half Of Marketplace Enrollees Utilized, And Required Individuals To Verify Their Information Every Year. According to the American Medical Association, “Section 71303 of the OBBBA ends the longstanding practice of allowing subsidized marketplace consumers to automatically reenroll in their plan, beginning in plan year 2028. This provision will require that all individuals take actionable steps to verify income and other information each year before the close of open enrollment and prior to receiving PTCs or cost-sharing reductions. Last year, more than half of marketplace enrollees auto-renewed their coverage without having to return to the marketplace.” [American Medical Association, Accessed 5/12/26]
- The Bill Ended A Provision Allowing Individuals To Temporarily Receive ACA Subsidies While Their Eligibility Was Verified. According to the American Medical Association, “Section 71703 also ends provisional eligibility for marketplace coverage, beginning in plan year 2028. Currently, individuals can receive an ACA subsidy for a limited time while their eligibility is being verified. These changes will make it harder to reenroll in coverage, and some enrollees will likely drop coverage altogether.” [American Medical Association, Accessed 5/12/26]
¶ The “One Big Beautiful Bill” Changed The Methodology For Calculating Premium Adjustments Which Was Expected To Increase Maximum Out-Of-Pocket Limits And Decrease Premium Subsidy Amounts
The “One Big Beautiful Bill” Changed The Methodology For Calculating Premium Adjustments Which Was Expected To Increase Maximum Out-Of-Pocket Limits And Decrease Premium Subsidy Amounts. According to the American Medical Association, “Technical changes in the CMS final rule, effective plan year 2026, are expected to increase marketplace consumers’ premium contributions and out-of-pocket expenses. One provision changes the methodology for calculating the premium adjustment percentage, which is a measure of premium growth that impacts several calculations and will raise consumers’ maximum out-of-pocket annual limit on cost-sharing while decreasing premium subsidy amounts.” [American Medical Association, Accessed 5/12/26]
¶ The “One Big Beautiful Bill” Expanded Tax Cuts For The Wealthy And Was Expected To Add $3.8 Trillion To The National Debt
The “One Big Beautiful Bill” Made 2017 Income Tax Breaks Permanent And Added An Estimated $3.8 Trillion To The National Debt Over 10 Years. According to CNN, “The package includes several controversial measures that would deeply cut into two of the nation’s key safety net programs – Medicaid and food stamps – while making permanent essentially all of the trillions of dollars of individual income tax breaks contained in the GOP’s 2017 Tax Cuts and Jobs Act. What’s more, it would fulfill Trump’s campaign promises to cut taxes on tips and overtime, albeit temporarily. The magnitude of the measures is evident in the estimates of the cost they would incur or the savings they would produce. […] The tax changes in the package would add $3.8 trillion to the nation’s debt over a decade, according to a Congressional Budget Office analysis released before last-minute changes were made to the bill.” [CNN, 5/28/25]
HEADLINE: "House Republican Budget Takes Away Health Care, Food Aid To Pay For Expanded Tax Cuts For Wealthy" [Center On Budget And Policy Priorities, 2/21/25]
¶ More Than 100,000 Nevadans Were Expected To Lose Health Care Due To Cuts In The “One Big Beautiful Bill” By 2034
¶ More Than 100,000 Nevadans Were Expected To Lose Health Care Coverage Due To Cuts In The “One Big Beautiful Bill” By 2034
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 “One Big Beautiful Bill” And The Expiring Affordable Care Act Tax Credits Would Result In 110,000 Additional Uninsured Nevadans By 2034
The “One Big Beautiful Bill” And The Expiring Affordable Care Act Tax Credits Would Result In An Additional 110,000 Uninsured Nevadans By 2034. According to the Center For American Progress, “The One Big Beautiful Bill Act will increase the number of Americans without health coverage in every state Estimated increase in the uninsured population due to the OBBBA and the expiration of the ACA’s enhanced premium tax credits, 2034”
[Center For American Progress, 9/5/25]
¶ The Affordable Care Act Allowed States To Expand Medicaid, Which Dramatically Lowered The Uninsured Rate Among Low-Income Workers
The Affordable Care Act Allowed States To Expand Medicaid, And States That Expanded Medicaid Dramatically Lowered The Number Of People Without Health Insurance. According to the Center on Budget and Policy Priorities, "The Affordable Care Act (ACA) permits states to expand Medicaid coverage to adults with incomes up to 138 percent of the poverty level (about $20,780 annually for an individual or $35,630 for a family of three). States that have adopted the expansion have dramatically lowered their uninsured rates. Extensive research finds that the people who gained coverage have grown healthier and more financially secure, while long-standing racial inequities in health outcomes, coverage, and access to care have shrunk." [Center On Budget And Policy Priorities, 6/14/24]
- The Uninsured Rate Among Low-Income Workers Fell From 38 Percent In 2013 To 17 Percent In 2022, Which Coincided With The Implementation Of Medicaid Expansion. According to the Center on Budget and Policy Priorities, "Millions of workers have gained coverage through Medicaid expansion, including people working in industries that provide critical goods and services such as health care, transportation, grocery stores, food manufacturers, and child care. Many have no access to health coverage through their jobs. In expansion states, the uninsured rate among low-income workers fell from 38 percent in 2013 to 17 percent in 2022; this sharp decline coincided with a large increase in the share of low-income workers enrolled in Medicaid.[16] In non-expansion states, the uninsured rate among low-income workers fell much less, from 46 percent to 31 percent. (See Figure 3.)" [Center On Budget And Policy Priorities, 6/14/24]