The number of Alaskans without any kind of healthcare coverage is on the rise and expected to continue climbing thanks to the votes of Republicans like US Rep. Nick Begich and US Sen. Dan Sullivan.
That’s because much of the GOP’s cuts to healthcare contained in the party’s signature 2025 legislation—The Big, Beautiful Bill—won’t actually go into effect until 2027, when new nationwide work requirements are expected to bump as many as 13,000 Alaskans off Medicaid coverage, with many simply getting lost in a state public assistance program already described as a “paperwork nightmare.”
That’s according to a report by the Alaska Department of Health from earlier this year, which estimates that between 9,400 and 13,600 Alaskans are expected to lose Medicaid once the requirement comes online. It finds that after all the exemptions written into the bill, only about 18,900 people would actually be subject to the work requirements.
Under the state’s best-case scenario, half are expected to make it through the labyrinth of paperwork and keep coverage, but the real-world experience suggests that number will be even less.
Arkansas, which is where Alaska based its study on, only had about 30% of eligible recipients keep coverage when it enacted its own work requirements.
And that’s on top of the 60,000 Alaskans who have already lost Medicaid coverage since President Donald Trump reentered the White House last year, according to data collected by the Georgetown University Center for Children and Families, a number that includes nearly 20,000 children and pregnant women who rely on Denali KidCare.
Affordable Care Act recipients suffer, too
The healthcare headaches aren’t limited to Alaskans reliant on Medicaid, but also people who buy health insurance through the Affordable Care Act’s individual marketplace, such as independent contractors and small business owners. That’s because Republicans let enhanced premium tax credits—a COVID-era policy that helped keep insurance affordable for millions of Americans—expire at the end of last year, despite a widespread outcry to extend them.
Republicans like Begich have claimed their opposition is because the system was apparently rife with fraud.
“Temporary extensions without meaningful reform are not the solution,” Begich said in January after voting against extending the credits. “Real reform that puts patients first is.”
No solution has materialized in the subsequent nine months, and the fallout has been nightmarish.
Mark Robokoff, who owns an Anchorage pet supply store, told the Anchorage Daily News that he’ll likely have to go without insurance soon after his monthly premium went from $950 per month in 2025 to $2,860 per month with the expiration of the credits. If the latest 26% rate hike requested by the marketplace’s main insurer, Premera Blue Cross Blue Shield, is approved, he expects to pay more than $3,600 a month.
“It’ll probably mean I’ll drop health insurance,” he said. “Our system is just so broken. This will be me throwing my hands into the air and canceling my health insurance and just crossing my fingers and hoping for the best.”
The combination of people being priced out of private insurance and others losing Medicaid coverage is expected to drive up Alaska’s already-high rate of people without insurance. According to federal data, 14.2% of adults under 65 are uninsured and about 10% of children lack any health insurance.
Heathcare cuts will hurt all Alaskans
Advocates warn that the loss in coverage will hurt everyone.
That’s because as coverage goes down, people tend to get less regular treatment, end up sicker, and ultimately end up relying on costly emergency room care that someone, at the end of the day, has to pay for. Those costs end up on people with insurance, thereby making the insurance more expensive.
“We know that the people who lose their coverage or their care, their costs don’t disappear. They just shift to other areas of our healthcare system,” said Rep. Genevieve Mina, D-Anchorage, at a Sept. 4 event on coverage losses. “Hospitals and clinics absorb that uncompensated care, and who pays for that? Everybody else in the market.”
Under one estimate, the amount of uncompensated care in Alaska is expected to grow by 9.7%, equating to about $87 million in costs that will need to be absorbed by someone. For some parts of the state that’ll mean more expensive care for thoes who still have coverage, and in other parts of the state that’ll mean no care in the long run as clinics are forced to close.
That’s a problem already facing Alaska before much of the Big, Beautiful Bill’s cuts come online. In 2025, Healy’s health clinic closed citing budget issues, and in 2026, Anchorage’s queer-focused health clinic Identity Health Clinic shut its doors, citing delayed Medicaid payments.
At his 2026 address to the Alaska Legislature, Begich downplayed the impact of the cuts to healthcare coverage, suggesting that the real solution to lower healthcare costs is simply healthier people. It’s a common thread of what has become to be known as the “Make America Healthy Again” movement under US Health Secretary Robert F. Kennedy Jr.
“The MAHA movement is not just a slogan,” Begich said. “There’s a real reason why we need to be healthier, because if we can lower demand on the healthcare system, we will lower the costs for everyone. … Because if we can make people healthier, it’s far better than if they’re not right.”
But losing healthcare coverage doesn’t exactly make people healthier.
At least that was the experience in Arkansas with its work requirements, where one study found that people who lost Medicaid coverage were more likely to delay care and skip medications than those who remained on Medicaid. It also found that the impact on employment rates, ostensibly the whole point of the exercise of implementing the requirements, did not meaningfully change during the time they were in effect.
In the big picture, with Trump still holding veto power, it’ll be difficult for a Democrat-controlled Congress to reverse the course that Sullivan and Begich put the state on. That means much of the headache will need to be dealt with at the state level, which has been a growing focus in Alaska’s race for governor.
At a healthcare forum last week, even Republican candidate for governor Dave Bronson acknowledged the Big, Beautiful Bill will cause extra problems for Alaska, committing to seeking an extension for the state to comply with its requirements.
But it was Democrat Jonathan Kreiss-Tomkins who said that Alaskans need to remember who it was that was responsible for creating the mess—Begich and Sullivan.
It is important to be “very clear about who voted for that legislation that is about to make it harder for Alaskans to get the care they need,” he said. “We need to be very clear-eyed about that.”
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.
