Nurses at University Medical Center of Southern Nevada (UMC) say they’re feeling the pinch of looming federal cuts from President Donald Trump’s “One Big Beautiful Bill” at the same time the hospital's CEO Mason Van Houweling receives an almost $300,000 pay bump. 

“That would have been several positions saved,” Jodi Dominick, a health care worker and a union leader for Service Employees International Union (SEIU), said in an interview with The Nevada Independent last week. 

At an Oct. 7 Clark County Commission meeting, the board voted to approve a previously negotiated raise of more than 7 percent to UMC’s CEO’s base salary of $840,000, bringing his compensation to more than $1 million this year including bonuses. UMC is a public hospital owned by Clark County — the only one of its kind in Las Vegas — and is partially funded by local property taxes. 

The board voted to approve the raise 6-1 with Republican April Becker as the sole dissenting voice. During the meeting, Becker sharply criticized the raise. 

“I have a huge issue with this level of pay occurring in a public hospital for a county employee,” Becker said. 

The commissioners’ vote comes after more than $200 million in cuts from the federal government this summer in what experts called “the biggest healthcare shake up” since the introduction of the Affordable Care Act (ACA). 100,000 Nevadans are set to lose Medicaid coverage in the first two years after the budget bill’s work requirements are implemented; almost three quarters of a million Nevadans use the program. UMC alone faces an estimated $45.4 million in losses out of a $1 billion annual operating budget — nearly half of the hospital's patients are insured through Medicaid. 

Since the federal health care funding slashes, SEIU said 36 nonunion supervisory positions were eliminated, with the possibility of 68 more layoffs — 50 of which are unionized positions. UMC has contradicted this statement, and says only 17 positions have been cut. The hospital is negotiating with staff on cost-saving measures, nurses said, though Van Houweling’s raise had not been discussed. 

“It was a slap in the face,” Dominick said about the salary increase. 

According to a report brought before the county commission last week, Van Houweling had met 93 percent of CEO objectives, which included financial, clinical and human resources goals. Van Houweling’s salary is comparable to CEOs at public hospitals across the country, which are typically much lower than CEOs of private hospitals.  

Without Medicaid coverage, local hospitals will be footing the bill when uninsured people are unable to pay for their medical care costs. Uninsured patients are also likely to stop getting checkups and minor preventative care — instead, they might wait until an ailment turns into an emergency.

Chris Cochran, a UNLV professor in the School of Public Health, said this will increase the strain on hospital systems. 

“What we’re going to see is hospital emergency rooms are going to experience a huge uptick in admissions, because that’s what people are going to rely on,” Cochran said. 

Effect on hospitals and staff

In a UMC Audit and Finance Committee meeting this July, Jennifer Wakem, chief financial officer for UMC, said the cuts were expected to eventually “significantly affect UMC’s operation,” with significant reductions in revenue from the government-funded insurance program beginning in 2028. 

In a statement to the Nevada Democratic Party at time of the funding changes, Van Houweling said the funding shortage would bring “adjustments” to the way the hospital was run, including changes in staffing, expense management, evaluation of services provided and “other measures.” 

Elizabeth Bolhouse, a pediatric nurse at UMC, said she thinks the hospital is trying to build a budget surplus in preparation for when the federal budget cuts take effect. 

Nurses say patients and health care workers are the ones who will suffer. Bolhouse described a shift where a supervisor told her that she had to send a nurse home despite Bolhouse’s concerns about safe staffing levels. Later, she said she had a conversation with Van Houweling about her frustrations with working conditions at the hospital before the county commission vote. 

“I told him I was either going to cry or quit,” Bolhouse said. “Instead of quitting, I had a quick cry, buckled up and got things done.” 

Bolhouse said the conversation made her curious about Van Houweling’s compensation, which is when she found out about the Clark County Commission meeting. 

Van Houweling didn’t respond to a request for an interview before this story was published. But Kendrick Russell, a spokesperson for UMC, said Van Houweling’s salary is "commensurate” to other public hospital CEOs around the country. 

In Chicago, Cook County’s public hospital CEO Dr. Erik Mikaitis received a salary of $713,000 last year, with bonuses and raises of up to 10 percent, according to The Chicago Tribune. In Atlanta, the public Grady Memorial Hospital’s CEO John Haupert received a salary of $2 million, according to a 2023 tax filing. 

Salaries for the role are on the rise — a 2024 study from Rice University shows that CEO salaries for nonprofit and independent hospitals increased almost 30 percent from 2012 to 2019. Van Houweling’s base salary was $380,000 when he started in 2014, according to an article from the Las Vegas Sun.  

The federal funding cuts are also threatening service offerings of rural hospitals in Nevada, which might mean that patients outside of Las Vegas will have to travel to the city for medical care. Nurses said the potential increased patient load, alongside the UMC’s cost-saving measures, will only continue to affect the quality of care they can safely provide patients. 

“I don’t think the American population has realized what the ‘Big Beautiful Bill’ is going to do to our fellow Americans, as far as health care stability, health affordability and the wellness of our nation,” Bolhouse said. 

Bolhouse and Dominick said they have had colleagues go on unemployment benefits to support themselves and their families as their hours have been slashed or reduced to save money. Bolhouse said some are only working one shift a week, not enough to cover their expenses. 

“When [health care workers] are pinching pennies, and they’re doing everything they can to try to take care of the patients with less, and then hearing about these bonuses is an insult,” Dominick said. 

Care for the uninsured

Before the Affordable Care Act, Cochran said 20 percent of Nevadans were uninsured — today, 10 percent are. With stricter eligibility for Medicaid and deep cuts to ACA subsidies on the horizon, more people might be forced to go without health care insurance. Insurance premiums on the individual market — which includes the state’s Affordable Care Act marketplace and all non-employer health insurance coverage — are set to rise by an average of $147 per person per month, according to The Nevada Independent’s reporting. 

Most hospitals, including UMC, are bound by Emergency Medical Treatment and Labor Act (EMTALA) laws, meaning that they must see patients regardless of their ability to pay. Cochran said the county would likely absorb some of the cost of the Medicaid cuts. 

“When it comes to the uninsured, everybody pays … People still get sick, there’s still going to be demand,” Cochran said. “The question is, ‘How do we pay for these services?’” 

Because of EMTALA laws, Cochran said hospitals would not lay off staff to the point that they had to turn people away. Instead, Cochran said insurance premiums would likely rise for those with insurance, or it would fall on the taxpayers of Clark County to make up the difference. 

According to Cochran, the full effects of ACA cuts would likely not play out for at least a year or so. But Nevada could see a return to a time when more people went into serious debt for their medical bills. 

“You’re going to see a lot of people declaring bankruptcy because they won’t be able to afford their bills if they don’t have insurance,” Cochran said.

UMC said in a statement that they were collaborating with SEIU in order to minimize the impacts of the “Big Beautiful Bill,” also known as HR1. 

"We continue to work alongside our team members and partners from SEIU Local 1107 to develop and implement innovative cost-saving measures that will minimize the need for future staffing adjustments. While HR1 will certainly affect UMC, it will not disrupt the momentum we have built in recent years,” according to a  statement from UMC. 

This story was updated at 9:10 a.m. on 10/15/25 to add information about the contract vote.