Sullivan says he is among Republicans working on extension of health insurance subsidies

Nov. 24—Alaska's U.S. Sen. Dan Sullivan said Monday he is working on a bill seeking a two-year extension of health insurance subsidies that will otherwise expire at the end of the year.

The subsidies are used by many of the roughly 25,000 Alaskans who purchase insurance on the federal exchange through the Affordable Care Act. If allowed to expire, many would see premiums double or triple — increasing health care costs by tens of thousands of dollars for some families and putting health insurance out of reach for others.

Sullivan, a Republican, has previously signaled his support for extending the enhanced premium tax credits, which were adopted with support from congressional Democrats in 2022. But he did not push for the tax credits to be extended as part of a deal to fund the government and end what became earlier this month the longest government shutdown in U.S. history.

To appease Democrats, the deal to fund the government included a promise for the Senate to vote on a proposal to extend the subsidies by mid-December.

Now, with the shutdown over, Sullivan said bipartisan talks are underway to temporarily extend the subsidies and introduce other health care reforms.

"We're very focused. I'm trying to work with both sides of the aisle and the White House to get a resolution to this," Sullivan said.

Alaska's U.S. Sen. Lisa Murkowski has also spoken in favor of extending the tax credits.

Other GOP senators have been considering a broader set of changes to the Affordable Care Act, including replacing premium subsidies with personal health savings accounts. Sullivan said his focus has been primarily on a short-term extension of the subsidies "to enable people to prepare" for changes in how much health insurance will cost and how it will be paid for.

"What my bill is focused on is tapering the cliff," Sullivan said after addressing the Anchorage Chamber of Commerce on Monday.

Though Senate Democrats have been in vehement support of extending the enhanced premium tax credits — a goal that in large part drove the government shutdown — Sullivan said "it's not clear" where Democratic leadership stands on the health care proposals that Republicans are backing.

Sullivan said he was hoping that President Donald Trump would get behind the idea of extending the tax credits to bolster support for the move. Trump had previously indicated he did not support the extension. However, Sullivan's remarks Monday came as the White House indicated an openness to extending the subsidies.

Sullivan's goal of extending the tax credits by two years raises questions about whether such a move would set up a new "cliff" in 2027, bypassing the political peril of the 2026 midterm elections, when Sullivan and other members of Congress will face voters, but not bringing long-term relief to those who rely on the subsidies to afford insurance.

Sullivan said the answer to that lies in "broader reforms," including transitioning away from tax subsidies to tax-advantaged health savings accounts, which could be used to cover the cost of premium or co-pays.

Alaskans who rely on plans purchased through the Affordable Care Act say that the health savings accounts would change their calculus, but not necessarily solve the problem of lowering the cost of health care.

"If his concept is to give us money directly that we can then use to go and purchase a health care system, why not just take the final extra step and put everybody on Medicare for all? It's just adding more and more layers to the convolution," said Anchorage business owner Mark Robokoff in an interview earlier this month. Robokoff relies on enhanced premium tax credits to afford insurance and could see a tripling in his premium cost if the subsidies expire.

Since the passage of the Affordable Care Act under President Barack Obama, the percentage of Alaskans going without health insurance has declined, from roughly 20% in 2012 to roughly 10% in 2023. But at the same time, the cost of insurance premiums has been rising steadily, particularly in Alaska, where a single insurer — Premera Blue Cross Blue Shield — largely controls the marketplace.

"The big winner from Obamacare has not been Alaskans in terms of affordable health care. We haven't had that at all. It's the insurance companies," said Sullivan.

When it comes to proposed reforms, Sullivan did not name any policies that would aim to curtail the power of insurance companies. Nor did he name any policies that could be used to incentivize greater competition in the Alaska insurance market.

The proposed policies that Sullivan listed include tightening income requirements for accessing tax credits; requiring that all insurance enrollees pay a monthly premium (currently, enrollees below a certain income threshold pay nothing in premiums); and banning undocumented migrants from using the Affordable Care Act plans, which is already outlawed.

As Sullivan spoke inside the Dena'ina Convention Center, roughly a dozen protesters gathered outside the building in freezing temperatures, waiving signs that criticized the senator for a variety of policies.

One protester, Courtney Moore, said that she opposed Sullivan's stance on health care, among other issues.

Without the extension of the enhanced premium tax credits, she said she would have to go without insurance. But she said she wanted to see Sullivan support "an actual solution."

"Universal health care, like every single other civilized nation, would be incredible," she said. "People shouldn't go bankrupt for getting sick or hurt. People shouldn't be billionaires or millionaires making a profit off us being sick."

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