Alaska Republicans celebrate ‘common sense’ Medicaid work requirements for non-Natives
Recipients of Medicaid and food stamps—including thousands of Alaskans—will eventually have to work or volunteer at least 80 hours a month to get benefits under the so-called One Big Beautiful Bill supported by Sens. Lisa Murkowski, Dan Sullivan and Rep. Nick Begich the Third.
The Alaska Republicans defend this part of the Project 2025 agenda by claiming it’s common sense to require people to work and it will create an incentive for people on Medicaid and food stamps to be more responsible.
The law reduces Medicaid funding by $1 trillion over the next decade, but Sullivan and Begich insist that the national impact doesn’t matter because of various exemptions that will benefit Alaska for several years.
Murkowski said she didn’t like the bill, but if she hadn’t provided the deciding vote to pass it, the Republicans would have amended the measure to win over one of the other holdouts—Sen. Rand Paul in particular. Paul wanted far deeper cuts to Medicaid and other programs.
“And so it was no secret that the bill was going to pass. It was just a question of whether or not it was going to pass with Senator Paul’s vote, or with Senator Murkowski’s vote,” she said.
Had the Senate made the additional massive cuts in the social safety net to buy Paul’s vote, it would have laid the groundwork for a national 2026 election disaster for Republicans in Congress. To protect themselves in 2026, the Republicans delayed the effective date for many of their cuts until after the election.
But let’s get back to the common sense requirements supported by the trio for Medicaid and the Supplemental Nutrition Assistance Program, what used to be known as food stamps.
“There’s a common sense work and volunteer requirement for Medicaid and SNAP,” Sullivan boasted to the Alaska Federation of Natives convention last month. “But it does not apply to Alaska Natives. That is something else we worked to make sure didn’t happen.”
He gave no justification for the exemption. Neither did Murkowski in her speech to AFN, except to say the work requirements make no sense in rural areas of Alaska.
“Look we have rural villages, they’re rich in subsistence opportunities, but they simply do not have the same cash economies that fit federal work requirements, so it doesn’t work here. I made sure that tribal members would be exempted, fully exempted from these new work requirements for those on Medicaid and on SNAP,” Murkowski told AFN.
Begich told the Chilkat Valley News that the work requirement exception for Alaska Natives is justified because of a “treaty trust obligation” and that Medicaid should be regarded as a supplement to the Indian Health Service.
The federal government has failed to fund the IHS the way it should, according to Begich. This contradicts his statement that he was “honored” to vote for the bill that cut Medicaid by $1 trillion, a move that will make conditions more difficult for those who rely on IHS.
Medicaid is not directly part of the Indian Health Service, which funds medical care for Alaska Natives. Begich claims that when taken with all the other exemptions for people who are unable to work, only a tiny number of Alaska Medicaid recipients will be required to work.
"So what we've tried to do is just isolate the very small group of folks who are not working, who could be working, are not a part of the traditional Medicaid population, and don't fall into those other categories, and just say simply, ‘Look, you have the ability to contribute. People around you are contributing, give something back,’” Begich told the Juneau Independent.
Seven percent of the Medicaid expansion population, he claims, will have to meet the common sense requirement.
The Republican claim is that many Medicaid recipients are not contributing enough to society and are sitting at home doing nothing, so work requirements are needed. As House Speaker Mike Johnson put it, “You return the dignity of work to young men who need to be out working instead of playing video games all day.”
Most Medicaid recipients are already working, but many don’t get paid much.
Alaska Natives living in Anchorage or Fairbanks will not have to meet the common sense requirements to qualify for Medicaid. People who are not Alaska Natives but live in Tanana or Bethel or Kotzebue will have to show they are working or volunteering to qualify.
The common sense work requirements will mean the state will have to institute new systems for monitoring compliance twice a year, which will include deciding who is eligible and who is not on a continuing basis.
Sullivan, Murkowski and Begich haven’t explained how much common sense will cost in setting up a compliance system that applies to a “very small group of folks,” as Begich claims.
The state explains the new rules this way: “The bill requires that most able-bodied adults ages 19–64 enrolled through Medicaid expansion must complete 80 hours per month of work or other qualifying activities to qualify for Medicaid coverage. These activities include job training, education, or volunteer service. Individuals must show they met the requirements at least one month before applying and must meet the same requirements when they renew.”
The Alaska trio won’t say so, but the real goal of common sense work requirements is to create bureaucratic hurdles that people relying on Medicaid will be unable or unwilling to clear. Their common sense assumption is that some people on Medicaid and food stamps do not have the mental and social skills to navigate the byzantine rules of a bureaucracy.
The plan from Murkowski, Sullivan and Begich the Third is that people who are not Alaska Natives will give up and fail to file the paperwork to stay on the rolls, which will lower the cost to the government by reducing the number of recipients.
And the exemption for Alaska Natives allows them to stand before AFN and claim a great political victory from the rules the Republicans insist must apply to others. It’s just common sense.
“The Congressional Budget Office (CBO) estimates the Medicaid work requirement provisions in the passed budget reconciliation law will be the largest source of Medicaid savings, reducing federal spending by $326 billion over ten years and cause millions to become uninsured,” the Kaiser Family Foundation says.
“KFF analysis shows most Medicaid adults under age 65 are working already (without a requirement) or face barriers to work. Many Medicaid adults who are working low-wage jobs are employed by small firms and in industries that have low employer-sponsored insurance offer rates. In previous analysis, CBO found that a Medicaid work requirement would not have any meaningful impact on the number of Medicaid enrollees working, and cited research from Arkansas indicating that “many participants were unaware of the work requirement or found it too onerous to demonstrate compliance,” resulting in coverage loss.”
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