When Senate Republicans released the latest version of their sprawling domestic policy package in the wee hours of Saturday morning, it contained a number of new provisions that might have seemed out of place — including a measure aimed at helping Alaskan whaling captains.
But the seemingly random items were anything but arbitrary; they appeared to be aimed at winning the support of a critical Republican holdout whose vote could make or break the measure: Senator Lisa Murkowski.
Ms. Murkowski has made no secret of her problems with her party’s bill and the harm she believes it could bring to her state. Chief among her concerns were new work requirements for Medicaid recipients and a provision that would require states to pay for a share of nutrition assistance payments currently paid entirely by the federal government.
“I want to try to do what we can to address certain aspects of our entitlement spending,” Ms. Murkowski said in an interview last weekend on CBS. “We’ve got to do that. But doing it with the most vulnerable bearing the brunt of that is not the answer.”
As G.O.P. leaders scrounged on Saturday for the votes to pass the legislation, they seem to have addressed many of her concerns, insulating Ms. Murkowski’s state from some of its most painful cuts while including an assortment of other Alaska-friendly provisions in the bill.
The latest version, which leaders hoped to begin voting on as early as Saturday afternoon, would provide a new tax exemption to fishers from villages in western Alaska. There is now an exemption from new work requirements for food assistance. And several provisions have been added that would funnel federal dollars to Alaskan health care providers.
There is even a provision that would allow certain Alaskan whaling captains to deduct more of their expenses. Right now, people recognized by the Alaska Eskimo Whaling Commission as captains can write off $10,000 in whaling-related expenses, like buying explosive projectiles, as a charitable contribution. The Senate bill would allow them to deduct $50,000 of their costs this way.
The late-stage, state-specific giveaway has a long congressional history. When votes are tight on major pieces of legislation, undecided lawmakers have considerable leverage to demand special goodies. Some have even been memorialized with catchy nicknames, like the “Cornhusker Kickback,” a Nebraska-friendly provision Democrats added to the Affordable Care Act to win the vote of then-Senator Ben Nelson, which was ultimately excised from the bill when it was discovered.
But Ms. Murkowski appears to have secured an unusually large number of special provisions in the bill making its way through Congress.
While some of them clearly mention Alaska, others are more oblique. A provision that would boost the amount the federal government pays Alaska for its Medicaid program refers to “the state with the highest separate poverty guideline” (that’s Alaska). The food aid provision applies to “noncontiguous states.”
Many of the new additions also benefit Hawaii, a state with no Republican representatives in Congress. That is because of the complex maneuver that Republicans are using to navigate their bill through Congress while sidestepping a filibuster. The process, known as budget reconciliation, is governed by a restrictive set of rules that frowns on provisions that target a single entity — like, say, the state of Alaska. By using a description that can apply to more than one state, Republicans may be able to avoid challenges to the new Alaska-friendly provisions.
Some of the measures will protect Alaska’s legislature from having to decide whether to shoulder new costs the bill would pass onto states or to cut programs like SNAP, formerly known as food stamps, and Medicaid. Other states will still have to make these hard choices.
The legislation would force states for the first time to pick up the costs of SNAP if they report a certain error rate, the rate at which state agencies mistakenly underpay or overpay SNAP recipients. Alaska has reported the highest error rate in the country by far, meaning the state would have to foot the bill for 15 percent of the program’s benefit costs.
The new version of the legislation released on Saturday would exempt Alaska from that new cost-sharing requirement. And it would allow “individuals in a noncontiguous state” to be exempted from the SNAP work requirements.
Earlier versions of the legislation already had exempted Native Americans and Alaska Natives from the new work requirements imposed on both SNAP and Medicaid beneficiaries — and had protected people who travel out of state for medical care, a common practice among Alaskans with serious medical conditions.
To soften the blow to Alaska of the Medicaid cuts in the bill, a new provision governing the share of medical bills paid by the federal government says that Alaska’s rate should be 25 percent higher than what a typical state gets. (It is such a large increase that the bill also specifies that the payment can’t go higher than 100 percent of the state’s medical bills.)
And the measure boosts Medicare payments to certain medical providers for care “furnished in Alaska and Hawaii.”
Several senators from rural states lobbied for and won a special rural health fund in the bill, which would help blunt the effects of its extensive Medicaid cuts. The $25 billion fund isn’t Alaska-specific, but it could benefit the state disproportionately. The fund was designed to offset restrictions on a budget gimmick that 49 states — but not Alaska — use to fund their Medicaid programs.
Andrew Duehren contributed reporting.
Catie Edmondson covers Congress for The Times.
Margot Sanger-Katz is a reporter covering health care policy and public health for the Upshot section of The Times.
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