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Sen. Lisa Murkowski reaped a bounty from the Big Beautiful Bill
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Overnight, the Senate radically altered its Big Beautiful Bill, zeroing in on one state and one Senator in an attempt to buy her vote.
Sen. Lisa Murkowski (R-AK) expressed several concerns about the Medicaid and SNAP (Supplemental Nutrition Assistance Program, commonly known as food stamps) cuts to the bill. A joint op-ed from the legislative leadership in Alaska in The New York Times explained that 40,000 residents would lose health coverage and thousands more would lose SNAP benefits. “The shift in costs from the federal government to the state will plunge our budget into a severe deficit, cripple our state economy and make it harder to provide basic services,” state House Speaker Bryce Edgmon and state Senate Majority Leader Cathy Giessel wrote.

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The changes to the latest text made to attract support from moderate concerned about the deep nature of the budget cuts were largely performative. A $15 billion program to support rural hospitals was increased to just $25 billion, a joke when you consider that the Medicaid cuts in the same bill total $930 billion, according to a preliminary Congressional Budget Office estimate. The cuts to the provider tax were mostly maintained but delayed only one year, from 2027 to 2028; it remains to be seen whether the parliamentarian will even allow that. (Critically, Alaska is the only state that doesn’t use the provider tax maneuver to increase resources for its Medicaid program.)
But the gifts to Alaska, designed to sway Murkowski, came fast and furious. The federal share of payment for Medicaid would be increased for “the state with the highest separate poverty guideline.” That happens to be Alaska. Their share would increase 25 percent above that of a typical state.
Other programs bundle together benefits for “noncontiguous states,” referring to Alaska and Hawaii. That includes an exemption from work requirements for SNAP, an increase in Medicare reimbursement rates to select health care providers, and a waiver from the cost-sharing provisions, whereby a state must contribute to SNAP funding. As long as the noncontiguous state is “actively implementing a corrective action plan” to reduce error rates in the program (meaning people given benefits who do not qualify), that cost share can be eliminated. Alaska has the highest error rates in the nation, but under this provision, by simply saying they’re trying to fix it, they can avoid the cost share.
The reason Hawaii is getting this bounty is to get around the rules of budget reconciliation, where everything must have primarily a budgetary purpose. If Alaska were singled out by itself, then Democratic could charge that the riders were simply policy meant to benefit Alaska. If “noncontiguous states,” a phrase that appears 11 times in the new text, get the benefits, then Republicans can argue they’re doing it to account for the unique circumstances of states that have higher costs due to their geography.
It’s a stretch, but they only have to convince the Senate parliamentarian, and the inclusion in the final text suggests confidence that this will be successful.
However, other benefits truly only benefit Alaska-based interests. For example, western Alaskan fishing villages get a special tax exemption. And Alaskan whaling captains will be able to deduct $50,000 of their business expenses as a charitable contribution, up from $10,000 under current law.
The suite of perks is reminiscent of the “Cornhusker Kickback,” an increase to Nebraska’s federal Medicaid funding in the Affordable Care Act designed to influence then-Sen. Ben Nelson, a Democrat. But Murkowski is winning not only a Medicaid boost for her state, but a half-dozen other things. It’s not one but several kickbacks in the bill, none of which will definitively stay in, as the parliamentarian will have to scrub the text. (Nelson gave up the kickback and still voted for the ACA, incidentally.)
Meanwhile, there are major cuts to the clean energy tax credits that have been added back in. The Orphan Cures Act, a bill that exempts certain drugs from ongoing Medicare price negotiations, was stuck in at the last minute. Some expansions of health savings accounts were also put back in. These are all to attract House conservatives, the major stumbling block to get this bill accepted by the House. It’s unclear whether that will be enough, since the bill will almost certainly be more expensive than what they originally sent over.
Finally, the compromise SALT provision would increase the cap on state and local tax deductions to $40,000 (up from $10,000) for five years, after which it would snap back to $10,000. One SALT Caucus member, Rep. Nick LaLota (R-NY), said he would vote no because of that change. Another House Republican, Rep. David Valadao (R-CA), announced his no vote because of Medicaid changes; his district has one of the highest Medicaid rates in the country. The House can still pass the bill without those two, but they can’t lose many more.
Murkowski has not yet said whether her Gold Rush will get her to yes on the bill. But her vote is critical. Sens. Rand Paul (R-KY), Ron Johnson (R-WI), and Thom Tillis (R-NC) have all said that they will not vote to proceed on the bill this afternoon. That’s the maximum number of votes Republicans can lose, assuming that all Democrats vote no (which they will).
Sen. Susan Collins (R-ME), who has expressed concern throughout the process, said she would vote for the motion to proceed on the bill, but that she would be offering amendments that would be critical to getting her final vote. But she and Murkowski appear to be the only votes in question. Sen. Josh Hawley (R-MO), for example, who was particularly animated about cutting Medicaid, said he would vote yes despite the $930 billion in Medicaid cuts.
So for this afternoon, it all comes down to Murkowski. The vote is scheduled for 4:00pm ET.