Shortly after the U.S. House passed the Republican megabill, continuing tax breaks and cutting Medicaid, about two dozen protesters gathered on the street outside the Anchorage offices of Alaska’s congressional delegation.
Kim Anderson said she was devastated, especial by Sen. Lisa Murkowski's vote.
“I flew all the way to DC. I talked to Murkowski personally," said Anderson, a caregiver who has relied on Medicaid for the therapy needs of the former foster children she adopted. "She said she understood, that she was going to fight for us."
Alaska is in a special position in the budget reconciliation bill that cleared Congress Thursday without a vote to spare. Murkowski was the pivotal vote in the Senate, and she voted for it only after extracting special concessions for her state. But the bill is predicted to leave nearly 12 million Americans without health insurance, and many Alaskans don't like the bargain Murkowski struck.
Congressman Nick Begich called the bill "a transformative victory" for Alaska. He issued a statement lauding the bill’s mandate to offer millions of federal acres in the Arctic and Cook Inlet for oil and gas lease sales.
Sen. Dan Sullivan also spoke of it as an Alaska success, with, among other things, substantial funding for the Coast Guard and 16 icebreakers.
“I think it's safe to say that no state fared better from this bill than our state,” he told Alaska reporters.
The bill is a top priority for President Donald Trump, too. Among its approximately 1,000 pages are large sums for defense and border security as well as tax breaks and spending cuts that disproportionally benefit wealthier households.
Murkowski is the only one of Alaska’s congressional delegation who expressed substantial uncertainty about the bill. She said she made a bad bill better for Alaska
"I tried to take care of Alaska's interests," she said after the Senate vote Tuesday. "But I know ... that in many parts of the country there are Americans that are not going to be advantaged by this bill. I don't like that."
State Rep. Genevieve Mina, an Anchorage Democrat who chairs the House Health and Social Services Committee, said it’s a national misconception that the concessions Murkowski won make the bill a net-positive for Alaska.
“There's a lot of talk about how there's Alaska carveouts or a Kodiak kickback or a polar bear provision. These were not good deals for the state either," she said. "They're provisions that would risk so much to the rest of the nation.”
Nationally, the bill would reduce Medicaid spending by more than $1 trillion over a decade. It would also shift some of the cost of food assistance to the states. Murkowski got a two-year delay in some of that burden-shifting.
Mina said she didn't think that would solve Alaska’s longstanding challenges processing Medicaid and food assistance applications. The bill will require the state to take on even more administrative work by verifying eligibility more often and tracking that beneficiaries meet new work requirements or have waivers.
Maybe the biggest win Murkowski got was boosting a fund for rural health care to $50 billion.
“ I don't want to sound ungrateful, because that's better than the alternative,” said Jared Kosin, president of the Alaska Hospital and Health Care Association.
It's impossible to know how much of that $50 billion Alaska will get, Kosin said, after studying the bill's requirements.
"The State of Alaska is going to have to have an application approved by the federal government by Dec. 31 of this year, and it's got to be a 'detailed rural health transformation plan,'" Kosin said.
Then, hospitals and clinics would apply to the state, not knowing how much they’ll get.
Meanwhile, Kosin said, thousands of Alaskans are going to lose Medicaid coverage and will be forced to use hospital emergency rooms — either for primary care at essentially the highest cost to Alaskans as a whole, or because they are in crisis for lack of primary care.
“They're going to show up in our facilities, and we're going to do our best to take care of them," he said. "But at the end of the day, that is a terrible model of health care in our state and any other state, regardless of how much money is flowing in.”
Rev. Elizabeth Schultz, who works for the regional Presbyterian organization, was among thousands of Alaskans who urged Murkowski to reject the bill.
She felt "deep disappointment and anger" when Murkowski helped the Senate pass it.
Schultz said she does not doubt that many groups in Alaska will benefit from the tax breaks and the special carveouts Murkowski won.
“And I don't disparage that, but I'm not sure it was worth what it will mean for the rest of the country," she said. "And I think when you're in a position of that much power that she had at that moment, she could have used it for the benefit of the country.”
Other Alaskans are singing Murkowski’s praises. Ann Brown, former chair of the Alaska Republican Party, wrote an op-ed for the Anchorage Daily News saying Murkowski was an artful negotiator.
"Alaska owes her gratitude for delivering a good deal," Brown wrote. "Those complaining in other states should start delivering for their own voters."
Murkowski's willingness to defy Trump has often alienated her from the Alaska Republican Party. Now a bloc she's relied on for support — the middle and left — feel betrayed. Hundreds of angry Alaskans have posted on social media, vowing to never vote for Murkowski again.
