On Tuesday evening, Robert VerBruggen of National Review noticed
something odd: The financial projections produced by Sen.
Bill Cassidy’s office showed that, in 2026, his healthcare
proposal would award each state almost precisely $4,400 in
federal subsidy for each “eligible beneficiary” — except Alaska,
which would receive $6,500, or 48% more than everybody else.
Hmm. Do we know
anybody from Alaska?
Making things odder: Neither VerBruggen nor I could locate the
provision in the bill that seemed to authorize this Alaska
So I asked a staffer in Cassidy’s office and was told it was
revising the projections. The spreadsheet came down off the
senator’s website after I inquired about it.
The staffer said a forthcoming version of the projections would
reflect a bonus for low-density states whose healthcare costs are
more than 20% above the US mean. These states would get a bump in
the rate they’re paid per beneficiary to account for their higher
The bill defines a “low-density state” as one with fewer than 15
residents per square mile. There are five such states, but
according to Kaiser Family Foundation only
two of them have per capita health spending more than 20%
above the US mean: Alaska and North Dakota.
No North Dakota bonus was reflected in the spreadsheet from
Cassidy’s office; maybe that will change in the new projections,
or maybe they’re relying on different figures that put North
Dakota (22% above mean, by Kaiser’s estimate) below the 20%
cutoff. Maybe North Dakota’s representatives will vote on this
bill with no idea what its financial treatment of North Dakota
would be — that would be consistent with the rest of this
Alaska has very high healthcare costs and today receives large
per-person federal subsidies to help finance healthcare. Because
Alaskans who participate in individual markets established by the
Affordable Care Act are unusually reliant on federal healthcare
subsidies, most of the Republican healthcare proposals have
tended to be very bad for the state. But this Alaska Purchase
provision would seem to result in Alaska experiencing only a
fairly modest cut in spending per capita, instead of the enormous
ones that Graham-Cassidy would impose on other high-cost states
Delaware, because it’s high density — or perhaps because it votes
Democratic — would be out of luck.
We’ll see what the new projections show and whether this special
deal for Alaska is enough to win over the support of Sen. Lisa
Murkowski of Alaska, who has opposed previous plans to repeal the
ACA, better known as Obamacare. Murkowski has raised varied
objections to prior healthcare bills, including to their efforts
to defund Planned Parenthood, which this bill would also seek to
Because the overall cuts in Graham-Cassidy are large, Alaska
would lose money relative to current law despite its special
treatment (at least according to the latest version of the
projections posted by Cassidy’s office), which may be a reason
Alaska’s independent governor has announced opposition to the
It’s really great that everyone has to figure these extremely
consequential matters out on the fly because Republicans in
Congress want to overhaul healthcare on the back of an envelope.
Graham-Cassidy healthcare bill has Alaska Purchase for Lisa Murkowski