Republican U.S. House Rep. Nick Begich answers a question during a debate on Thursday, Oct. 10, 2024, in Anchorage, Alaska. (Bill Roth/ADN)
JUNEAU — State lawmakers are urging the Alaska congressional delegation to oppose cutting Medicaid and to extend tax credits that made marketplace insurance affordable for thousands of families in the state. But Alaska’s all-Republican members of Congress are split in their approach to changing federal policies that shape access to health care in a state that sees some of the highest costs in the country.
Resolutions from the Alaska Legislature come as Republicans in Congress seek to make hundreds of billions of dollars in cuts to the Medicaid budget and end programs under the Affordable Care Act, in an effort to finance a tax cut sought by President Donald Trump. The U.S. House is set to take a final vote on those cuts next week.
Alaska’s lone U.S. House member, Republican Rep. Nick Begich, has been supportive of a GOP plan to implement work requirements for Medicaid. That plan is expected to cause millions of Americans to lose access to the program, according to the Congressional Budget Office.
Begich did not respond to multiple interview requests and questions sent to his office this week about his position regarding the specific changes sought by congressional Republicans.
Begich early Wednesday reposted a social media message from North Dakota Republican Rep. Julie Fedorchak, which Begich said addressed “Medicaid facts vs. Democrat fiction.”
[Divisions emerge among House Republicans over how much to cut taxes and Medicaid]
Fedorchak wrote that Democrats were spreading “lies” about cuts to Medicaid, and that Republicans were seeking to implement work requirements for certain Medicaid recipients and ban residents of the U.S. without legal status from receiving Medicaid.
Some health care providers and majority legislators in Alaska say that the work requirements sought by Republicans would have the result of needlessly kicking people off of their insurance, eventually raising the cost of delivering health care in the state by pushing vulnerable Alaskans to more expensive forms of care.
“Work requirements don’t save money. They are designed to create an inefficient bureaucracy that churns people out of the system and denies care. So it increases costs and it increases mortality. We did share that with Congressman Begich,” said Rep. Zack Fields, an Anchorage Democrat, during a committee hearing last month.
Alaska health care providers said in a hearing last month that kicking people off Medicaid would not reduce the cost of health care in Alaska — where costs are among the highest in the nation — because eventually those people may need medical care, whether or not they have insurance.
Uninsured Alaskans who seek care in emergency rooms are treated even if the hospital does not expect those individuals to be able to pay for the cost of their care, meaning those costs are passed on, including in the form of higher premiums for privately insured Alaskans.
Joshua Arvidson, chief operating officer of Alaska Behavioral Health, told lawmakers that when Alaskans do not have health insurance, they delay the treatment they need, ultimately making the care they require more expensive and complex.
“When they delay seeking health care, their conditions are more severe when they do enter into treatment, and therefore treatment takes longer and it’s more expensive,” said Arvidson.
Arvidson said that lack of access to effective mental health care — which is facilitated in large part through Medicaid — could lead Alaska to experience a rise in unemployment, crime rates and homelessness.
The Alaska Senate passed a resolution earlier this month in a 14-6 vote asking Alaska’s congressional delegation to “oppose cuts to federal spending on Medicaid to protect the state’s health care system, communities, citizens, and economy.” The House is expected to vote on the resolution before the end of the session.
Lawmakers said earlier this session that cuts to federal spending on Medicaid could force the state to either pare back its offerings or increase its share of spending — a prospect that the Legislature largely wrote off due to the state’s budget constraints.
Separately, the Legislature earlier this week passed a resolution urging Congress to extend premium tax credits offered under the Affordable Care Act, which cut the cost of marketplace plans by thousands of dollars annually for Alaskans who qualify. Those tax credits are set to expire later this year without action from Congress to extend them.
Alaska U.S. Sen. Lisa Murkowski has been one of the lone Republicans in Congress to speak in favor of extending ACA premium tax credits, a move that is broadly supported by congressional Democrats and opposed by many in the GOP.
Alaska U.S. Sen. Dan Sullivan “is fully aware that the cost of health insurance in Alaska is high, and that many working Alaskans can better afford health care coverage because of the enhanced tax credits,” his spokesperson Amanda Coyne said in a written statement Wednesday. Sullivan has not committed to supporting an extension of the tax credits.
The expiration of those credits would “result in the more than doubling of health insurance premiums for thousands of state residents,” according to the Alaska resolution, which passed with support from 26 out of 40 House members and 15 out of 20 Senate members.
The resolution states that 23,000 Alaskans have made use of the tax credits to lower the cost of premiums for health insurance purchased through the ACA marketplace.