The end of the longest-ever government shutdown came without any meaningful progress on a looming spike in health care costs — a route supported by Alaska U.S. Sen. Dan Sullivan and other Republicans — and tens of thousands of Alaskans will soon pay the price.
The expiration of the enhanced insurance subsidies — a Biden-era policy that made buying health insurance through the marketplace free or nearly free for low-income households and nearly affordable for middle-class households — will more than double insurance premiums for many of the nearly 29,000 Alaskans who rely on marketplace coverage.
For many Alaskans, the increases will be even bigger.
AK Bark owner Mark Robokoff, one of the many small business owners who rely on the marketplace for coverage, told the Anchorage Daily News that his insurance premiums are set to triple, going from $924 to $2,886, if there’s no extension of the subsidies.
“This will pull the rug out from under me,” said Robokoff. “I thought I was doing the things that a society wants its members to do — create new businesses, create new jobs, improve the life of the surrounding community.”
The health insurance marketplace was created by the Affordable Care Act and has become the go-to source of health care coverage for small businesses, freelancers and a wide range of Alaskans with a wide range of employment who wouldn’t otherwise be able to get coverage through an employer or Medicaid and Medicare (like your author, who was on marketplace insurance from 2017 to 2020).
The enhanced subsidies were created in 2021, extending federal assistance to anyone buying insurance on the marketplace rather than the previous cap of 400% of the poverty level. It meant that for many low-income households, buying insurance on the marketplace was free or nearly free and somewhat affordable (we’re still talking $500 to $1,000 monthly premiums with a deductible around $4,000) for everyone else.
That expanded affordability proved to be a hit, coinciding with a significant uptick in the number of Alaskans buying that kind of insurance.
Prior to the credits, enrollment in the marketplace settled around 18,000 Alaskans. Enrollment spiked to 22,000 in the first year of the new subsidies. That trend has continued with the state currently sitting at 28,736 enrollees, according to KFF.
For many, the nearly affordable plans were a key to starting new businesses or working outside the usual large employer structure.
Robokoff told the paper the increased costs will force him to rethink much of what has made his small business flourish over the last few years. It’s a similar story for many other Alaskans, who will have to rethink their work, dedicate much of their income to health care coverage or go without insurance, relying more and more on emergency care.
Outside the U.S. Rep. Nick Begich’s office earlier this month, Stand Up Alaska organizer Erin Jackson told a rally collecting food for the Food Bank that the fight for affordability extended to everyone, noting that she, too, relies on marketplace insurance and would have to rethink a medical procedure she was planning for next year. She criticized Begich and fellow Republicans as out of touch with the struggles of everyday Alaskans.
“It’s not just about people that need SNAP,” she said. “It’s people like me, who are relatively privileged, who will not have health care next year because my premiums have gone up from $497 to $2,417. So, I will not have the hip surgery that I need. I may or may not have the medication that I need … Why is his pain more important than ours?”
While Democrats tried to use the shutdown to force Republicans to act on the subsidies, Republicans like Sullivan and Begich insisted that the government reopen before they’d even consider negotiating, effectively wasting more than a month. Sullivan has also continued to claim that the insurance marketplace is somehow riddled with fraud.
“I am working very diligently on reforms and extensions to these subsidies, and I’m hopeful that we’re going to be able to get there,” Sullivan said in early November. “Senate Majority Leader Thune, President Trump, the Speaker of the House, they’ve all said, of course, we’ll have negotiations on this. Let’s open the government. We’re holding people as hostages, and let’s get those negotiations and discussions going.”
The lone concession Republicans made was a promise to hold a Senate vote on the issue in mid-December, but there have been no promises from the House or President Trump, who has since turned to an oddball idea: giving Americans health care spending accounts so they can shop around for health care.
The idea has faced significant blowback from people who understand the U.S. health care system, particularly the part where it’s not at all designed for patients to shop around for services.
“In theory, it seems like a good idea,” said Mona Shah, senior director of policy and strategy at Community Catalyst, told CNN. “The reality is even if that [price] information is accessible, how many people could navigate that, understand the differences, have the time to do that and then make informed decisions?”
The lack of direction among Republicans is stark and doesn’t suggest there’s much confidence that anything will come of it. That’s horrible news for the many Alaskans who relied on the marketplace to get barely affordable coverage, especially given that people are currently shopping for health care coverage.
The deadline to start coverage on Jan. 1, 2026, is Dec. 15.
Matt Acuña Buxton is a long-time political reporter who has written for the Fairbanks Daily News-Miner and The Midnight Sun political blog. He also authors the daily politics newsletter, The Alaska Memo, and can frequently be found live-tweeting public meetings on Bluesky.
