Alaska U.S. Senators Lisa Murkowski and Dan Sullivan (Alaska Beacon file photos)
Alaska Republican Sens. Lisa Murkowski and Dan Sullivan joined Senate Democrats and a handful of other Republicans on Thursday in voting to extend federal subsidies that would have prevented a major spike in health care prices at the end of the year.
Sixty votes were needed to advance a bill containing the extension, but the vote failed 51-48. An alternative Republican-backed bill, which would have offered marginal help to offset the cost increases, also failed despite support from Murkowski and Sullivan.
Barring additional action before Jan. 1, thousands of Alaskans and millions of Americans who buy health insurance through the federal marketplace will pay significantly more for health care next year.
“I would just suggest that we have failed,” Murkowski said in a floor speech following the votes.
Sullivan, in a written statement, said in part that “there is little doubt that a lot of hard-working Alaskans, families, entrepreneurs and small business owners will be negatively impacted if these enhanced premium tax credits expire.”
Both Murkowski and Sullivan said they would continue working to try to find a compromise before the end of the year.
The failed Democratic proposal would have offered a flat three-year extension of subsidies that were put in place during the COVID-19 pandemic emergency and extended during the Biden administration.
Most Republican senators opposed a flat extension and emphasized instances of fraud and abuse, saying that further changes were needed to the program.
Even with those changes, the Republican-backed proposal offered only a small cash payment and didn’t extend the subsidies; many Americans and Alaskans would still face large cost increases.
“Now that both the Republican and Democrat proposals failed to advance, I will redouble my efforts to develop a compromise solution. In the longer-term, we need to focus on getting federal government health care dollars out of the hands of insurance companies and into the hands of the people,” Sullivan said in his statement.
Health care costs. Stethoscope and calculator symbol for health care costs or medical insurance
By: Jennifer Shutt, States Newsroom
Health care costs. Stethoscope and calculator symbol for health care costs or medical insurance
WASHINGTON — The U.S. Senate in long-anticipated votes failed to advance legislation Thursday that would have addressed the rising cost of health insurance, leaving lawmakers deadlocked on how to curb a surge in premiums expected next year.
Senators voted 51-48 on a Republican bill co-sponsored by Louisiana Sen. Bill Cassidy and Idaho Sen. Mike Crapo that would have provided funding through Health Savings Accounts for some ACA marketplace enrollees during 2026 and 2027.
They then voted 51-48 on a measure from Democrats that would have extended enhanced tax credits for people who purchase their health insurance from the Affordable Care Act Marketplace for three years. A group of Senate Democrats in November agreed to end a government shutdown of historic length in exchange for a commitment by Republicans to hold a vote on extending the enhanced subsidies.
Republican Sens. Susan Collins of Maine, Lisa Murkowski and Dan Sullivan of Alaska and Rand Paul of Kentucky voted for the Democrats’ bill. Paul also voted against the GOP bill.
Neither bill received the 60 votes needed to advance under the Senate’s legislative filibuster rule.
Senate Majority Leader John Thune, R-S.D., criticized the ACA marketplace and the subsidies for leading to large increases in the costs of health insurance.
“Under Democrats’ plan insurance premiums will continue to spiral, American taxpayers will find themselves on the hook for ever-increasing subsidy payments,” Thune said. “And don’t think that all those payments are going to go to vulnerable Americans.”
Thune argued Democrats’ bill was only an extension of the “status quo” of a “failed, flawed, fraud program that is increasing costs at three times the rate of inflation.
Thune said the Republican bill from Cassidy and Crapo would “help individuals to meet their out-of-pocket costs and for many individuals who don’t use their insurance or who barely use it, it would allow them to save for health care expenses down the road.”
Schumer calls GOP plan ‘mean and cruel’
Senate Minority Leader Chuck Schumer, D-N.Y., said the three-year extension bill was the only option to avoid a spike in costs for people enrolled in ACA marketplace plans.
“By my last count, Republicans are now at nine different health care proposals and counting. And none of them give the American people the one thing they most want — a clean, simple extension of these health care tax credits,” Schumer said. “But our bill does extend these credits cleanly and simply and it’s time for Republicans to join us.”
Senate Minority Leader Chuck Schumer, D-N.Y., speaks to House Minority Leader Hakeem Jeffries, D-N.Y., during a Hanukkah reception at the U.S. Capitol Building on Dec. 10, 2025 in Washington, D.C. (Photo by Anna Moneymaker/Getty Images)
Schumer referred to the Cassidy-Crapo proposals as “stingy” as well as “mean and cruel.”
“Under the Republican plan, the big idea is essentially to hand people about $80 a month and wish them good luck,” Schumer said. “And even to qualify for that check, listen to how bad this is, Americans would be forced onto bare-bones bronze plans with sky-high deductibles; $7,000 or $10,000 for an individual, tens of thousands for a couple.”
After the votes failed, Schumer outlined some of the guardrails Democrats would put in place regarding negotiations with GOP colleagues.
“They want to talk about health care in general and how to improve it — we’re always open to that, but we do not want what they want — favoring the insurance companies, favoring the drug companies, favoring the special interests and turning their back on the American people,” he said.
Health Savings Accounts in GOP plan
The Cassidy-Crapo bill would have the Department of Health and Human Services deposit money into Health Savings Accounts for people enrolled in bronze or catastrophic health insurance plans purchased on the ACA marketplace in 2026 or 2027, according to a summary of the bill.
Health Savings Accounts are tax-advantaged savings accounts that consumers can use to pay for medical expenses that are not otherwise reimbursed. They are not health insurance products.
ACA marketplace enrollees who select a bronze or catastrophic plan and make up to 700% of the federal poverty level would receive $1,000 annually if they are between the ages of 18 and 49 and $1,500 per year if they are between the ages of 50 and 64.
That would set a threshold of $109,550 in annual income for one person, or $225,050 for a family of four, according to the 2025 federal poverty guidelines. The numbers are somewhat higher for residents of Alaska and Hawaii.
The funding could not go toward abortion access or gender transitions, according to the Republican bill summary.
Members of Congress have introduced several other health care proposals, including two bipartisan bills in the House that would extend the enhanced ACA marketplace tax credits for at least another year with some modifications.
Speaker Mike Johnson, R-La., has been reluctant to bring either bipartisan bill up for a floor vote, though he may not have the option if a discharge petition filed earlier this week garners the 218 signatures needed.
Pennsylvania Republican Rep. Brian Fitzpatrick wrote in a statement the legislation represents a “solution that can actually pass—not a political messaging exercise.”
“This bill delivers the urgent help families need now, while giving Congress the runway to keep improving our healthcare system for the long term,” Fitzpatrick wrote. “Responsible governance means securing 80 percent of what families need today, rather than risking 100 percent of nothing tomorrow.”
But Johnson said Wednesday that he will put a package of bills on the House floor next week that he believes “will actually reduce premiums for 100% of Americans who are on health insurance.” Details of those bills have not been disclosed.
Thune told reporters that if “somebody is successful in getting a discharge petition and a bill out of the House, obviously we’ll take a look at it. But at the moment, you know, we’re focused on the action here in the Senate, which is the side-by-side vote we’re going to have later today.”
Alaska’s Murkowski said lawmakers can find a compromise on health care by next week “if we believe it is possible.”
Political costs
The issue of affordability and rising health care costs is likely to be central to the November midterm elections, where Democrats hope to flip the House from red to blue and gain additional seats in the Senate.
The Democratic National Committee isn’t waiting to begin those campaigns, placing digital ads in the hometown newspapers of several Republicans up for reelection next year, including Maine’s Collins and Ohio’s Jon Husted.
“Today’s Senate vote to extend the ACA tax credits could be the difference between life and death for many Americans,” DNC Chair Ken Martin said in a press release. “Over 20 million Americans will see their health care premiums skyrocket next year if Susan Collins, John Cornyn, Jon Husted, and Dan Sullivan do not stand with working families and vote to extend these lifesaving credits.”
White House press secretary Karoline Leavitt blasted Senate Democrats’ proposal during Thursday’s press briefing, calling it a “political show vote” meant to provide cover for Democrats, whom she blamed for creating the problem.
Trump and Republicans would “unveil creative ideas and solutions to the health care crisis that was created by Democrats,” she said. “Chuck Schumer is not sincerely interested in lowering health care costs for the American people. He’s putting this vote on the floor knowing that it will fail so he can have another talking point that he can throw around without any real plan or action.”
Shauneen Miranda and Jacob Fischler contributed to this report.
Wooden gavel with books in background, News of the North File
The state of Alaska has settled lawsuits against Juul and Altria, two nicotine vapor manufacturers, for a combined $7.8 million, the state Department of Law said on Friday.
The suits were part of a nationwide pattern: Alaska and other U.S. states had alleged that the companies deliberately targeted children with advertising, something that likely contributed to a surge in nicotine use among children and young adults.
Altria settled Alaska’s lawsuit for $2 million last year, and the state announced a $5.8 million consent judgment with Juul on Friday.
Under the settlements, neither Juul nor Altria must admit fault, but both must abide by marketing restrictions. One key point in the settlement: Juul can’t use cartoons to advertise its products.
“This case took five years and a great deal of work from our public health and consumer
protection teams, but it was worth it,” said Alaska Attorney General Stephen Cox, in a prepared statement.
“We now have strong court-enforceable limits on how these companies can operate in
Alaska, and we’ve obtained a per-capita recovery that ranks near the top nationally, with
those dollars going straight into prevention and consumer protection.”
Alaska was one of the last states in the country to settle with Juul, which has already paid more than $1 billion to states across the country.
Some states have since filed additional lawsuits against vape distributors, alleging that they contributed to a surge in nicotine vapor use among children and young adults.
Money from Alaska’s Juul settlement is to be paid over the next five years.
Under the financial terms of the consent judgment, half of the proceeds would be used to fund tobacco control and prevention programs, and the other half would go to the Department of Law’s consumer protection program.
Typically, the spending of money earned in financial judgments must be approved by the Alaska Legislature before becoming official.
“The use of vapes and other nicotine products among youth in Alaska remains a concern,” said Alaska Department of Health Commissioner Heidi Hedberg in a prepared statement. “This funding will help families and communities continue to access education, prevention, and cessation programs.”
Downtown Skagway, with snow dusting its streets, is seen in this undated photo. (Photo by C. Anderson/National Park Service)
This article was reported and published in collaboration between the Chilkat Valley News and the Alaska Beacon.
Skagway’s former paramedic is alleging wrongdoing by the Southeast Alaska town, saying in a newly filed lawsuit that she was illegally fired after submitting a grievance against the city’s fire chief and deputy fire chief.
In a lawsuit filed Nov. 20 at Juneau Superior Court, Samantha Philemon — the town’s lone licensed paramedic for much of her employment since 2023 — alleges she was fired due to disputes over recordkeeping and the department’s decision to purchase an all-terrain vehicle known as an Argo.
According to Philemon’s complaint, at the time of her firing, Skagway officials said she was being let go due to violations of HIPAA, the federal medical-privacy law. Philemon’s attorney says in the complaint that the accusation “was a sham.”
Philemon filed a formal complaint against the chief and deputy and was fired by Skagway’s deputy borough administrator the day after the complaint was resolved.
“We’re excited to have our day in court, so to speak, and we think that a jury who hears Sam’s story is going to do the right thing and understand what happened here, and we’re just looking for this to never happen again,” said her attorney, Miye D’Oench of the Anchorage-based Northern Justice Project.
Philemon said her firing has left Skagway, a town of roughly 1,100 year-round residents, without a trained paramedic.
“There are firefighters with EMT 1 and EMT 2 and some (EMT) 3 training, but there are no paramedics, and that harms the community because paramedics are trained and licensed to do things that EMTs are not,” she said.
Neither Fire Chief Emily Rauscher nor Borough Manager Emily Deach responded to requests for an interview that would allow them to respond to Philemon’s complaint.
The borough denied a public records request by the Chilkat Valley News. Robert Blasco, the city’s hired attorney, did not return messages left at his office on Friday and Monday.
Philemon moved from Mississippi to Skagway in 2023, she said, and enjoyed working with the department at first.
“I wanted to be between the mountains and the ocean,” she said.
According to the complaint, she encouraged a friend to work for the department this past summer, but when he arrived, he was told his position had funding for only one week. Philemon believed that was because the department had recently purchased an Argo.
When she raised the issue, according to the complaint, “Rauscher and Mead then turned on Ms. Philemon,” and “began silencing and excluding her from department business.” There were additional disputes about medical procedures performed by the fire department and accounting at the department..
Philemon submitted a formal grievance to the borough manager in July. The manager, Emily Deach, said in an August memo that Skagway “will take action to address the behavior and prevent reoccurrence” as well as take steps toward formalizing fire department training.
“The actions of the department supervisors do not require termination of those supervisors, as
you requested verbally,” Deach wrote to Philemon.
Philemon, who had been placed on administrative leave while the grievance was investigated, was ordered to return to work under a separate plan. She objected, concerned that she would be returning to work under the same supervisors and conditions as before, and appealed to a committee that included the Skagway Mayor.
The committee upheld Deach’s work on Sept. 10. Philemon planned to return to work, but the deputy borough manager fired her the following day.
Philemon said she’s been looking for work since then but hasn’t found success.
“I’m looking for a new job after being fired from a job that I never wanted to leave. I’m devastated because I love my job, and I love Skagway,” Philemon said.
Online court records show the case has been referred to Judge Amy Welch. No additional proceedings have yet been scheduled.
AP- Back from a week abroad, President Donald Trump threw himself into the shutdown debate, calling on the Senate to scrap the filibuster and reopen the government, an idea swiftly rejected Friday by Republican leaders who have long opposed such a move.
Trump pushed his Republican Party to get rid of the Senate rule that requires 60 votes to overcome objections and gives the minority Democrats a check on GOP power. In the chamber that’s currently split, 53-47, Democrats have had enough votes to keep the government closed while they demand an extension of health care subsidies. Neither party has seriously wanted to nuke the rule.
“THE CHOICE IS CLEAR — INITIATE THE ‘NUCLEAR OPTION,’ GET RID OF THE FILIBUSTER,” Trump said in a late night social media post Thursday.
Trump’s sudden decision to assert himself into the shutdown now in its 34th day — with his highly charged demand to end the filibuster — is certain to set the Senate on edge. It could spur senators toward their own compromise or send the chamber spiraling toward a new sense of crisis. Or, it might be ignored.
Republican leaders responded quickly, and unequivocally, setting themselves at odds with Trump, a president few have dared to publicly counter.
Senate Majority Leader John Thune has repeatedly said he is not considering changing the rules to end the shutdown, arguing that it is vital to the institution of the Senate and has allowed them to halt Democratic policies when they are in the minority.
The leader’s “position on the importance of the legislative filibuster is unchanged,” Thune spokesman Ryan Wrasse said Friday.
A spokeswoman for Wyoming Sen. John Barrasso, the No. 2 Republican, said his position opposing a filibuster change also remains unchanged. And former GOP leader Mitch McConnell, who firmly opposed Trump’s filibuster pleas in his first term, remains in the Senate.
House Speaker Mike Johnson also defended the filibuster Friday, while conceding “it’s not my call,” from his chamber across the Capitol.
“The safeguard in the Senate has always been the filibuster,” Johnson said, adding that Trump’s comments are “the president’s anger at the situation.”
Broad GOP support for filibuster
Even if Thune wanted to change the filibuster, he would not currently have the votes to do so in the divided Senate.
“The filibuster forces us to find common ground in the Senate,” Republican Sen. John Curtis of Utah posted on X Friday morning, responding to Trump’s comments and echoing the sentiments of many of his Senate Republican colleagues. “Power changes hands, but principles shouldn’t. I’m a firm no on eliminating it.”
Debate has swirled around the legislative filibuster for years. Many Democrats pushed to eliminate it when they had full power in Washington, as the Republicans do now, four years ago. But ultimately, enough Democratic senators opposed the move, predicting such an action would come back to haunt them.
He said in his post that he gave a “great deal” of thought to his choice on his flight home from Asia and that one question that kept coming up during his trip was why “powerful Republicans allow” the Democrats to shut down parts of the government.
But later Friday, he did not mention the filibuster again as he spoke to reporters departing Washington and arriving in Florida for a weekend at his Mar-a-Lago home.
While quiet talks are underway, particularly among bipartisan senators, Trump has not been seriously involved. Democrats refuse to vote to reopen the government until Republicans negotiate an extension to the health care subsidies. The Republicans say they won’t negotiate until the government is reopened.
House Democratic Leader Hakeem Jeffries said on CNN that Trump needs to start negotiating with Democrats, arguing the president has spent more time with global leaders than dealing with the shutdown back home.
“People are stressing,” said Sen. Lisa Murkowski of Alaska, as food options in her state grow scarce.
“We are well past time to have this behind us.”
Money for military, but not food aid
The White House has moved money around to ensure the military is paid, but refuses to tap funds for food aid. In fact, Trump’s “big, beautiful bill” signed into law this summer, delivered the most substantial cut ever to the Supplemental Nutrition Assistance Program, known as SNAP, projected to result in some 2.4 million people off the program.
Agriculture Secretary Brooke Rollins said Friday the agency cannot release contingency funds to keep SNAP running, but two judges ruled nearly simultaneously Friday that the administration must continue to fund the food aid program. How quickly that might happen remains to be seen, as further consultation with the courts is expected on Monday.
Trump, in a social media post, said administration lawyers will be asking the courts “to clarify how we can legally fund SNAP as soon as possible.”
“If we are given the appropriate legal direction by the Court, it will BE MY HONOR to provide the funding,” Trump said.
“We are holding food over the heads of poor people so that we can take away their health care,” said Rev. Ryan Stoess during a prayer with religious leaders earlier this week at the U.S. Capitol.
“God help us,” he said, “when the cruelty is the point.”
Deadlines shift to this week
The House remains closed under Johnson with no plans to resume the session, and senators left for the weekend and are due back Today.
The next inflection point comes after Tuesday’s off-year elections — the New York City mayor’s race, as well as elections in Virginia and New Jersey that will determine those states’ governors. Many expect that once those winners and losers are declared, and the Democrats and Republicans assess their political standing with the voters, they might be ready to hunker down for a deal.
If the shutdown continues into this week, it could surpass the 35-day lapse that ended in 2019, during Trump’s first term, over his demands to build the U.S.-Mexico border wall.
NOTN- A 35-year-old man was hospitalized early Wednesday after police say he was likely struck by a vehicle on Vintage Boulevard.
The Juneau Police Department said officers received a report around 12:37 a.m. of an unconscious man lying in the roadway near First Bank. When first responders arrived, the man regained consciousness but had injuries to his face, hands and legs.
Pieces of a vehicle were found nearby, and investigators, as well as relatives on Facebook believe the man had been hit by a car.
NOTN- When Emma’s son, Cade, was just five months old, she noticed he was falling behind on developmental milestones. Doctors told her he was “just a late bloomer.” But after years of searching for answers, specialists diagnosed Cade with SPG50, an ultra-rare genetic disease that slowly robs children of the ability to control their bodies.
The Juneau community has rallied behind Cade’s cause, A daylong radiothon hosted by KINY on Saturday raised $35,000 to support 4-year-old Cade Jobsis.
The event, ran from 10 a.m. to 5 p.m. and featured prizes such as a helicopter ride from NorthStar Helicopters, an Eaglecrest ski pass, and a yearlong membership to the Rainforest Playzone.
Funds will support Cade, who was diagnosed at just 2 years old with SPG50, a rare form of hereditary spastic paraplegia that causes progressive loss of mobility. Fewer than 100 cases are known worldwide.
His mother, Emma, said her family spent years searching for answers before receiving Cade’s diagnosis. Doctors initially told them there was no treatment.
“There’s only around 100 cases in the world, and because of that, there really isn’t any interest in treating this disease or developing treatments for a disease that’s so rare.” Said Cade’s mom, Emma Jobsis, “So when we left the hospital after hearing his diagnosis, the doctors basically told us, there’s nothing we can do. Take him home, love him, he’s going to fade way in front of your eyes, basically. And we were distraught, as any parent would be.”
Because of the disease’s rarity, pharmaceutical companies and government agencies have shown little interest in funding development. Instead, families like Cade’s are leading grassroots efforts to raise millions for research.
“We decided we just have to do it by any means necessary, we have to raise the money and get this drug through clinical trials, because I can’t live with the fact that the next mom is going to be sitting in the office hearing what I heard when there’s a drug that exists, but you just can’t get access to it because it’s not approved.” Jobsis said.
Emma said the Juneau community’s response has been overwhelming.
“My town has pulled off something incredible that I never expected. This kind of showing up from my community.” Said Jobsis, “People that I’ve never met in my entire life are texting, emailing, calling, telling me they heard my story, they heard about Cade, and they want to help. And it’s just, it’s so surreal to feel like the community backs you in such a huge way.”
Listeners heard interviews with Cade’s family and others around the world affected by SPG50, as well as with the Canadian father who helped create the experimental gene therapy.
“I have found so much good in people through this process, through this fundraising and advocacy, I’ve felt so much compassion and generosity.” Jobsis said, “Leaning on each other, that’s what it means to be in a strong community. And I’m so grateful to be here and to all Juneau and beyond, supporting us in this way.”
Organizers say the true prize was seeing the community come together for Cade’s future. Donations can still be made at cureforcade.com.
“I do think it’s important to recognize that we should be seeing thousands of people likely lose coverage from this,” said Jared Kosin, president and CEO of the Alaska Hospital and Healthcare Association.
Speaking to a room at Juneau’s convention center, they said if federal subsidies end, the cost of health insurance would rise so much that many Alaskans will go uninsured, discouraging them from getting checkups that could prevent serious illnesses. Hospitals would see a larger number of emergencies from uninsured people, straining them. It might even lead to an exodus from the state, as people seek alternative options and cheaper places to live.
“I worry about that,” said Kim Champney, executive director of the Alaska Association on Developmental Disabilities. “Because I think people will decide to leave Alaska because we have the most expensive health care in the country.”
Anton Rieselbach, with the Juneau Economic Development Council provided an analysis of cost estimates for Juneau. In Alaska’s capital city alone, 1,389 people receive health care via insurance plans bought through the federal marketplace. Right now, those Juneauites pay an average of $124 per month. If those subsidies expire, that will rise to $1,008 per month, an increase of more than 700%.
The council, a nonpartisan organization devoted to economic growth in the capital city, is worried about what will happen if the subsidies expire.
“We want people to be working and spending money, generating economic activity,” Rieselbach said, “but this just places another huge burden on people’s ability to spend their money in other arenas besides health insurance.”
A problem years in the making
The upcoming problem stems from federal subsidies enacted by Congress in 2021 and extended through the end of 2025. Those subsidies, known as “enhanced premium tax credits,” were applied on top of subsidies included in the original Affordable Care Act, which established the federal insurance marketplace.
Now, almost anyone who buys an individual health care plan through the marketplace gets some kind of subsidy.
Generally, that includes people whose employers don’t provide health insurance, self-employed people, and people who retired early and aren’t yet eligible for Medicare, which insures people with disabilities and people 65 or older.
Subsidies helped expand the number of people on federal marketplace plans from 11.4 million in 2020 to 24.3 million this year, allowing millions of Americans to get regular health care.
They also came at a high cost to the federal treasury: Extending them for another 10 years would cost $335 billion.
But if subsidies end, Alaska would be exceptionally hard-hit. The state has the highest health-care costs in the nation, which means unsubsidized insurance rates are high.
Of the 28,736 Alaskans who have health insurance policies through the federal marketplace, 25,170 receive the enhanced subsidies, according to figures published by the Centers for Medicare and Medicaid Services.
If the enhanced subsidies expire, the poorest Alaskans will still see their plans subsidized. Middle-class Alaskans would be hard hit.
According to estimates published in March by the Alaska Division of Insurance, a single 50-year-old who earns $58,650 per year would see their monthly health insurance cost rise from $282 per month to $407 per month for a “silver” plan. If they have a “bronze” plan, their costs wouldn’t change.
But Alaskans who earn more than 400% of the federal poverty line — $78,000 per year for an individual — would see their costs skyrocket.
In 2023, 2024 and 2025, the average cost of a health insurance marketplace plan in Alaska rose by more than 16% each year. In 2023 alone, the cost went up by an average of 18.4%.
That same 50-year-old would go from paying $534 per month for a silver plan to $1,415 per month. Under a bronze plan, their cost would go from $9 per month to $890 per month.
Lori Wing-Heier, the director of the Division of Insurance at the time of those estimates, called the increase “pretty horrific” for affected Alaskans.
“It’s an insane amount,” said Rep. Genevieve Mina, D-Anchorage, talking about the increase.
This spring, Mina sponsored and the Alaska Legislature passed House Joint Resolution 9, a bipartisan letter asking Congress to extend the subsidies.
Across the state this year, the average monthly premium for Alaskans of all ages and all plans was $971.43, but the average subsidy was $866.28, the Division of Insurance said in March.
Kosin, of the hospital and healthcare association, said his group thinks it’s “really important” to extend the enhanced subsidies.
Insurance is based on the concept of sharing risks and costs. The more people in an insurance pool, the better it works. Subsidies encourage healthy people to be a part of the health insurance pool, he said. If people drop off, the cost of caring for any individual person is spread among fewer members, and rates go up.
An extension relies on congressional action
For the moment, Alaskans only have estimates of what will happen if the subsidies expire. Open enrollment on the federal insurance marketplace starts Nov. 1. There’s a “window shopping” period at the end of October that will give a sneak preview.
People must sign up by Dec. 15 to get insurance coverage that starts with the new year. Miss that deadline, and Jan. 15 is the deadline to get coverage that starts Feb. 1.
Kosin said he’s heard the argument that Alaskans could afford health care before the enhanced subsidies came into effect, and so there won’t be many people who drop their coverage.
That fails to take into account the way health insurance costs have gone up since 2020, he said.
In 2023, 2024 and 2025, the average cost of a health insurance marketplace plan in Alaska rose by more than 16% each year. In 2023 alone, the cost went up by an average of 18.4%.
“If there truly is a doubling or tripling of premiums, especially at once, I think I would have to guess it would be a higher percentage than a fifth of the population that would consider themselves priced out of the market,” he said.
U.S. Sen. Lisa Murkowski knows plenty of those people.
“If you are a 60-year-old couple (earning about) $82,000 in Alaska, you would be looking at a premium increase … without enhancements, of $44,556. My husband and I are over 60. Now, granted, we’re not on the exchange, but I have a lot of friends are in that category, and I don’t know very many of them that could swallow an additional $44,000 a year to pay for their insurance if they’re on the exchange,” she said in a Sept. 17 phone call.
Murkowski is among the members of the U.S. Senate who have been trying for months, without success so far, to find enough votes to extend the subsidies.
Impending government shutdown
The issue has now gotten entangled with the impending government shutdown. Senate Democrats have demanded — among other things — a permanent extension of the health care subsidies, without changes, in exchange for their votes on keeping the federal government open.
Sen. Dan Sullivan also supports an extension of the subsidies, but “there’s no way I would ever vote for that,” he said of the Democratic plan.
“I do think there’s bipartisan support to get this done. We’ve just got to power through these different issues,” he said by phone.
He identified three hurdles for the subsidies.
“It’s how long you extend them; are there pay-fors (budget cuts to compensate for the cost of the extension) … but the most important and complicated — and we just did a deep dive on this, and I do think there’s bipartisan support on this, is reforms,” Sullivan said.
“We are looking at ways to reform the system to make it work for the people who need it and are using it honestly, but have a disincentive against those who have been abusing it,” he said.
“We’re getting there. It’s complicated. I think the reform piece is going to be the most complicated, but I’m hopeful, and I’m putting a lot of effort into it,” Sullivan said.
Murkowski is more interested in a straight extension without changes. She introduced a standalone two-year measure and voted against both Republican and Democratic proposals to keep the government open, saying one of her conditions was an extension of the subsidy.
Speaking by phone this month, Mina noted that an extension has the support of groups as far afield as the Anchorage Chamber of Commerce.
“I think if you’re directly on the insurance marketplace, you should be concerned. But also, if you care about economic diversification and startups, you should also be concerned,” she said.
If the marketplace doesn’t work, she noted, it would increase the costs of health care for everyone in the state because hospitals are required to treat people regardless of their ability to pay. If people can’t pay, that means their costs get shifted to people who can, increasing the health insurance rates of everyone, not just those on the marketplace.
“What I fear is that we’re regressing to the state that we were in (a decade ago) when we had all of these news articles about people paying like, $800, $1,000 a month for their health insurance, and we were able to stabilize that and find solutions to help people,” Mina said. “We’re just going backwards in that regard.”
This article will contain mentions of suicide. If you or someone you know is struggling please call or text 988 to reach the Suicide and Crisis Lifeline.
NOTN- September is Suicide Prevention Awareness Month, and advocates in Juneau say the observance is an important chance to break stigma and share resources.
Jessica Gray, of NAMI Juneau, said Alaska continues to face persistently high rates of suicide, with nearly 200 deaths each year.
‘In Alaska, suicide is the second leading cause of death for ages 10 to 24,” Said Gray, “Young people don’t want to feel like a burden. There’s so much stigma surrounding the topic as well. We don’t talk about mental health the same way that we talk about physical health.”
Gray noted that free resources are available statewide, including the Alaska Careline and the national suicide prevention hotline. Both are available 24/7 for people in crisis.
NAMI events throughout September have been aimed at creating open dialogue and community support.
A Wall of Remembrance launched during First Friday at the Juneau Arts and Culture Center.
Gray said building community connections is one of the most powerful protective factors against suicide.
“That’s why Suicide Prevention Awareness Month is so important, because it opens up the conversation, and it gives people a chance to know that they’re not alone, that it is okay to ask for help,” Gray Said “It is okay to have these conversations about such a hard topic. It’s really powerful in that sense, because it builds connection. And we know that connection is one of the primary protective factors for suicide.”
Support group meetings will be taking place for the rest of the month, visit NAMI’s calendar, available at NAMI Juneau’s website for more details.
An Anchorage Superior Court judge’s ruling has cleared the way for the state of Alaska to repeal its “80th Percentile Rule,” enacted by the state in 2004 as part of an attempt to reduce health care costs in the state.
The Dunleavy administration repealed the rule in 2024, saying it was counterproductive and argued it contributed to higher health care costs. Medical providers say that isn’t true and that repealing the rule will cause some clinicians to close down.
In 2023, a group of medical providers sued the state, alleging problems with the process used to repeal the rule. On Aug. 27, following a four-day bench trial in February, Judge Yvonne Lamoureaux ruled in favor of the state.
In her findings of fact and conclusions of law, Lamoureaux concluded that the repeal was not “unreasonable or arbitrary,” and the state did not conduct an improper procedure.
An appeal to the Alaska Supreme Court is possible.
When in place, the rule required that insurance companies reimburse out-of-network medical providers at a rate equal to the 80th percentile of charges for the given service.
If five clinics provide a given procedure, the required payment would be what the second-most-expensive clinic charges.
The rule was intended to prevent Alaskans from being left with large medical bills after visiting out-of-network clinics. The state and Alaska’s largest health insurance company, Premera Blue Cross Blue Shield of Alaska, contend that it required insurance companies to pay more for services than was warranted, contributing to higher insurance costs.
