Eye of the Beholder: Community Leaders on ‘Big Beautiful Bill’ Impact in Alaska

“Those are the people with multiple chronic diseases,” pointed out Emily Nenon, Alaska Government Relations Director for the American Cancer Society Cancer Action Network. “If we want to save money in the Medicaid system, we have to get to people before they develop these chronic diseases. That’s where preventative care comes in.”

Research shows that patients who can access preventative and primary care are healthier and will save the medical system money. Without Medicaid, individuals are far less likely to receive preventative services, resulting in increased emergency room visits and hospital admissions and delayed detection of diseases.

A Tangle of Red Tape

Supporters of the bill, which is meant to pay for an extension of tax rates lowered in 2017 by imposing stricter requirements for federal benefits, say the system will be stronger for the remaining recipients. However, Dr. Casey Gokey, chief medical officer at Anchorage Neighborhood Health Center, says Alaskans receiving Medicaid already face significant wait times and barriers to accessing coverage.

At the panel discussion, she related the story of a patient who was recently laid off from a job in the healthcare industry and whom Gokey suspected has laryngeal cancer.

“I wrote her a strongly worded letter and urged her to take it to the Medicaid office in person—to wait in line to beg for her application to be expedited—because if we wait much longer, her prognosis may shift from serious to terminal,” Gokey said.

Waiting in long lines to expedite a Medicaid application is, unfortunately, a common scenario for Alaskans in a backlogged system. The cost of delaying care will soar when more people get caught up in the additional red tape, panelists warned.

The legislation limits states’ use of provider taxes and state-directed payments to enhance federal Medicaid payments, but Sullivan points out that Alaska is the only state that has never done this, so that provision does not affect the state.

Barriers to Care and Food Security

What does affect Alaskans is the requirement for Medicaid beneficiaries to demonstrate proof of employment every six months to qualify for coverage. Panelists noted that many Alaskans work seasonally—whether on the North Slope, in commercial fisheries, or in tourism jobs—so proving employment creates another barrier to accessing healthcare.

“These work requirements might sound simple, but in practice they create a maze of paperwork and confusion,” Gokey stated.

Work requirements could cause an additional 14,000 Alaskans to lose coverage. Many of these individuals rely on SNAP as well as Medicaid; those who don’t may turn to an overburdened charity system to provide meals when facing new healthcare costs.

“We are a critical part of Alaska’s food system, our healthcare system, and we’re concerned about the compounding effects of all of these cuts together,” said Rachel Miller, chief advocacy officer for the Food Bank of Alaska.

She highlighted that SNAP puts money back into the state’s economy through benefits spent at local retailers. In 2023, SNAP recipients redeemed more than $280 million at more than 550 retailers in the state.

Murkowski says she was able to demand greater flexibility for SNAP in Alaska. She also anticipates further refinements as the bill returns to the US House, although a target to pass the entire package by July 4 is looming.

More Economic Impacts

At the time of the panel discussion, the bill was estimated to cut $230 million from Alaska’s Medicaid funding, shrinking the state’s economy and eliminating nearly 2,000 healthcare jobs. In the final bill, Sullivan helped negotiate a $25 billion increase in the Rural Health Transformation Fund, allocating $100 million to Alaska for five years.

Tighter work requirements, though, would eliminate an estimated 27,000 Alaskans from Medicaid. Phil Hofstetter, CEO of Petersburg Medical Center, says the costs of healthcare would shift to local providers.

The medical center, one of Alaska’s last independent, community-owned hospitals, has contributed nearly $700,000 over the last three years in income-based financial assistance to patients in Petersburg. “We cannot absorb the impact of massive Medicaid cuts that will hit our state if the budget reconciliation moves forward,” Hofstetter shared.

With the loss of critical revenue, healthcare providers will likely scale back services, reduce staff, and ultimately care for fewer people. Hofstetter emphasized the impact of delayed care, pointing out that in remote locales like Petersburg, delayed treatment can lead to costly medevacs when treatable conditions become emergencies.

Though the American Cancer Society considers ramifications of the budget reconciliation bill to be dire, Nenon emphasized that Alaskans have faced harsh realities before and found ways to adapt and overcome. “Alaskans have a history of coming together to solve community challenges,” she said. “We have a challenge before us, and that’s why we’re gathered here today.”