Health

Dozens of Juneau residents gathered outside U.S. Sen. Dan Sullivan’s office Friday to implore him to consider Alaskans’ reliance on Medicaid. 

The U.S. Senate is expected to vote soon on President Donald Trump’s megabill, which would limit Medicaid eligibility.

For many protestors, the threats to health care coverage were deeply personal. That’s the case for Kris Cheng, who held a homemade poster covered with photos of a boy, one where he is in a hospital. 

“It’s about my son and the fact that he’s on Medicaid after a severe traumatic brain injury,” she said. “And the fact that I’m scared it’s gonna be taken away.” 

Her son Henry is 23, and due to an accident nine years ago, he needs specialized care that he has to travel to Seattle for. Medicaid helps cover those visits, and without it, the costs would fall on their family.

“And without that, he can’t be independent,” Cheng said. “He needs these injections that he gets. He needs the specialized care for brain injury down there. When he doesn’t get it, he’s more susceptible to falls, which ends up costing everybody more money.” 

Cheng’s poster had the words “not a fraud” and “not a scammer” interlayed with the photos of Henry. She said that’s in response to messaging she’s heard from politicians about Medicaid recipients.  

“My son is not a waste, he’s not a fraud, he’s not an abuse of anything,” Cheng said. More than 200,000 Alaskans are covered by Medicaid and the equivalent program for children. The megabill, if passed, could make it harder for those recipients to continue receiving care, and some may lose insurance completely.

If you ask the chief advocate for Alaska’s hospitals and nursing homes, Jared Kosin, there are plenty of ways to improve health care in the state. He said reducing the number of people with health insurance isn’t one of them.

This is terrible health care policy,” said Kosin, who heads the Alaska Hospital and Healthcare Association. “The predominant issue with it is it’s premised on achieving a savings target, that’s what they’re after, to fund these tax cuts.”

The Republican megabill making its way through Congress would make significant changes to benefits programs like Medicaid and SNAP, which would affect Alaskans across the state. The so-called “big, beautiful bill” with tax and spending cuts is changing fast, and it’ll likely keep changing right up until the bill passes.

The Congressional Budget Office, Congress’s official scorekeeper, estimates that the version of the bill that passed the House would push 16 million Americans off of government-funded or -subsidized health insurance. Divide that by Alaska’s population, and you get somewhere in the neighborhood of 30 to 40 thousand Alaskans at risk of losing insurance, either from Medicaid, which the state calls DenaliCare, or the federal health insurance marketplace.

That doesn’t mean those Alaskans won’t need health care.

But Kosin said they won’t get it until it becomes urgent. Hospital emergency rooms have to see everyone, even those who can’t pay. That would push up the cost of healthcare for everybody else, he said.

“What you can expect from that is there’d probably be a pretty significant cost shift over to private insurance, and so you’d see an increase in premiums for everyone else to offset these massive losses,” Kosin said.

Kosin said the drop in the number of insured people, especially in low-income rural areas with many Medicaid patients, would force hospitals to cut back on services or even close their doors.

The bill House Republicans passed includes new work requirements for Medicaid. That means that every six months, you have to prove to the state, which administers the program, that you have a job and that you’re working at least 80 hours a month. Or that you’re exempt.

Right now, though, the state is already struggling to keep up with the paperwork it’s tasked with and has a well-documented backlog.

Billy Stapleton Jr. is a state benefits processor and union representative who went to Washington to push back on the bill, and said new paperwork requirements would make things worse.

“That would cripple us because Medicaid is renewed once a year,” he said. “Now we have to focus on one case and put eyes and hands on it twice a year.”

The Alaska Division of Public Assistance is already way behind. He said he’s currently, in June, processing applications for the Supplemental Nutrition Assistance Program, or SNAP, that have been pending since November.

The House version of the bill has provisions that would require Alaska to pay tens of millions of dollars for the SNAP program. And whether the state could afford to pick up the tab is unclear, said state House Finance Committee co-chair Andy Josephson, an Anchorage Democrat.

“Will the Legislature, writ large, and the governor support back filling those items? I don’t know. That’s an open question,” he said.

Another open question is whether the SNAP provisions make it into the final bill at all. And that’s a lot of what Alaska’s Senate delegation is saying right now: The bill is in flux.

A spokesperson for Republican Sen. Dan Sullivan said he’s working hard to ensure the final bill doesn’t reduce Alaskans’ access to Medicaid or SNAP benefits.

She said Sullivan generally supports work requirements for Medicaid and doesn’t see them as a cut. But, she said Sullivan has pushed for a variety of “exemptions and carve-outs to protect vulnerable Alaskans.”

“He will continue to work during implementation to ensure that paperwork and administrative burdens do not prevent people from accessing the critical safety net programs they rely on,” Sullivan’s communications director, Amanda Coyne, said by email.

The bill exempts most Alaska Native people, people in high-unemployment areas, parents, veterans, pregnant women and people with mental health conditions, including substance abuse issues.

At the same time, opponents say that just applying the exemptions would be challenging for the state and the applicants.

But another thing to note: the Senate’s working copy of the bill allows the federal government to exempt states like Alaska from implementing the work requirement through 2028, as long as the state makes a good faith effort to upgrade its systems to handle the new paperwork requirements. But there are no guarantees the state would get that exemption.

A spokesperson for Republican Sen. Lisa Murkowski said she continues to have concerns about the bill and its impact on Alaskans who depend on Medicaid and SNAP.

“The landscape is rapidly evolving and discussions are ongoing,” spokesperson Joe Plesha said in a statement.

It’s unclear when the Senate will take up amendments and start voting on the bill. But President Donald Trump is pushing for the final bill to be passed by the Fourth of July.

A Haines nonprofit has been working for years to build a large facility capable of churning out compost for farmers and gardeners. The facility itself is complete. But the plan has stalled for months amid a heated debate over a neighboring driveway that’s owned by the borough – and part of the local cemetery.

The non-profit, known as the Takshanuk Watershed Council, wants to use the driveway to access its new composting facility. Opponents say that’s inappropriate.

“We have stated over and over that the Cemetery does not have any land to give away,” Roc and Diann Ahrens, who have served as volunteer caretakers of the cemetery property for more than three decades, wrote in a public comment letter.

The issue came to a head late last week when the Haines planning commission considered the watershed council’s easement request. The conservation organization wants to use about .09 acres of cemetery land to transport material and turn around heavy equipment. The group would also build a bear-proof fence.

The bulk of the cemetery property, known as the Jones Point Cemetery, is across the street. And the request notes that the driveway site has been used as a driveway by neighboring landowners in the past. More recently it was strewn with abandoned boats, cars and tires.

“What we’re asking for here tonight is permission to build about 150 feet of fence to enclose about 40 feet of existing driveway,” Derek Poinsette, the watershed council’s executive director, said during the meeting.

Without the easement, he said, the organization might need to scale back its composting plans. Building a new driveway is possible, he added, but wouldn’t be easy.

“To just expand that into new terrain, with new fill and cutting trees down and all that, is expensive,” Poinsette said in an interview. “We don’t have that money, and I don’t know that we’ll be able to get money to do something like that.”

The application cleared the planning commission after hours of public comment dominated by opponents who were adamant that the watershed council should not be allowed to use cemetery land.

“I’m not opposed to composting at all. I’m opposed to you taking part of the Jones Point property. That’s inappropriate, you have another place you can put your access,” said Haines resident Randa Szymanski.

Critics also said the watershed council should have designed the facility to fit on its own property. Others thought the facility would just be bad for the cemetery — that it would generate noise and traffic and could attract bears.

During a phone interview, Ahrens said his main concern is that, due to Haines’ aging population, the cemetery should keep control over all of its land.

“The aged population that still lives here, [that’s] the reason that we’re starting to be concerned about running out of space,” he said.

He added that they’ve proposed building a columbarium on the driveway site, though in a June 11 memo, Haines interim Borough Manager Alekka Fullerton noted that the cost of a columbarium is not currently in the budget.

The watershed council, for its part, has pushed back against the suggestion that they should have built the facility elsewhere – and that they can just build a new driveway.

The organization owns about 50 acres in the area. Much of that is used for public trails and conservation work. The compost facility itself borders a wetland and a creek on two sides, which would complicate building a new access point.

Building the facility cost around $250,000 in grant funding. In an email, Poinsette said creating a new access point could cost that much or more.

During the meeting, Poinsette said the group explored buying or leasing the land in 2022. It was later determined that wasn’t possible due to the nature of the federal deed associated with the property, which says the land should not be sold or used for other purposes.

The borough later recommended pursuing a temporary easement. In 2024, an official with the Bureau of Land Management said in an email to the borough that the agency would not take issue with an easement allowing the use of the area as a driveway.

Poinsette said not having access to the driveway could lead to worse impacts for the cemetery.

“We might end up having to park equipment out on Takshanuk’s stretch of the road there, which is across from the cemetery,” he said. “That could be a greater impact, I would think, on the cemetery than if we were allowed to get off the road and back behind the screen of trees.”

Five planning commissioners voted in favor of the motion, with only Jerry Lapp voting against. Poinsette is a commissioner but did not vote due to his role with the watershed council. The full assembly is set to consider whether to approve or reject the request on July 8.

Joe Mishler has been an emergency responder for more than 40 years, about half of which he spent in Juneau. He’s retiring at the end of the month to take care of an aging family member. 

Mishler has spearheaded a team of mobile response units called Community Assistance Response and Emergency Services, or CARES, that address needs that can fall through the cracks. Things like follow-up medical care, housing support or substance use treatment. He says the program evolved out of in-home care during the COVID-19 pandemic. 

The teams can meet people where they are — at home, at a shelter, or on the street. 

KTOO’s Yvonne Krumrey met him at his office at the fire station to ask about what he learned, and what mobile response units do for the community.

The following transcript has been lightly edited for clarity.

Joe Michler: Basically, I oversee all of — it’s kind of like the non-emergency portion of the fire department. 

And basically we call it MIH, the Mobile Integrated Healthcare program, developed out of that. I think part of the reason it’s accepted and been as successful as it has is because it’s basically needs driven.

We identify needs. We identify from case management, from the hospital and from the clients. We talk to our patients and we determine what it is that they need, versus saying, “Hey, we have a program and we’re going to put this out onto the community.” It’s basically grown from the community.

Yvonne Krumrey: And I think one thing that really stands out about these this program is that it’s essentially kind of, I think, filled a lot of the gaps that sometimes city services can have with a little bit more as you say that it’s both medical care, social work and emergency response kind of in the same moment. And I feel like there’s not a lot of services that can often provide exactly that for somebody. And I’m wondering, how has the response been?

Joe Mishler: The response has been tremendous. Been very well received by the community.

We have some clients that we see that there’s really no other service for them, but we’re continuously getting referrals. 

We look at why they’re using the emergency services, and then try to try to help them solve their problem and make them self sufficient, so that we’re not continuously being their resource. 

So anyhow, there’s a lot of the times the resources are already here. People just don’t know about them. 

And you know, the biggest thing is, we think that we as paramedics save lives, and really, if we would approach—that’s where burnout comes from—because so much of what we do on the ambulance Isn’t life saving, but what we really do is we help people. 

Every crisis is different. But that’s what’s neat about this program, is so often in the ambulance, we simply pick them up, you’re not dying, shuffle you to the ER, there you go, go back out and do it again. Do it again and do it again. And here we actually get to try to figure out what’s going on and stop the cycle. We actually try to help people resolve things, you know?

Yvonne Krumrey: You know, do you get to see a lot of that, like resolutions for folks? 

Joe Mishler: Yeah, yeah. It’s very rewarding work. Since we’ve started, we’ve had very, very little turnover. The people really like the job they’re doing: meeting the people and developing relationships.  And a lot of the people we’re taking care of are very seriously ill. Many of them are at the end of life. And so we’ve had many of our clients over the years, over the last few years that have passed, and that’s that’s difficult. 

Yvonne Krumrey: Are there any moments you’ve had over the last 40 or so years that really stood out to you, like why this work matters so much? That really reinforced why you do what you do? 

Joe Mishler: One of the things that kind of stands out in my mind is over the years that I found out that little things that I’ve done, they really were, in my mind, no big thing. But someone else, it was huge. And I’ve had people thank me for things, or come back or or even talk about things, but a lot of times it’s the little things and just being nice, nice to people and helping them take care of them when they’re having a really, really, really bad day, that probably does as much in helping people as all of the medical training and everything else that we do.

Alaska’s rates for childhood vaccinations are well below the national average, and the percentage of kindergarteners who had received all recommended vaccines was the lowest last year since at least 2017, according to a new report from the state Department of Health.

Only 54% of kindergarteners in the state had received all of their recommended vaccinations in 2024, according to a bulletin issued by the department’s epidemiology section. That compares to a national rate of about 93%, according to the U.S. Centers for Disease Control and Prevention.

There are six recommended vaccines for severe illnesses for kindergarten-age children, and Alaska rates fall below the national average for all six, including polio and chickenpox. For the combined measles, mumps and rubella vaccine, commonly called MMR, only 76% of Alaska kindergarteners in 2024 had completed the recommended two-dose series, the bulletin said. That compares to a 93% national rate for the MMR vaccine, said the bulletin, which documented a downward drift in vaccination rates over recent years.

Measles is a highly contagious respiratory virus, causing fever, cough, runny nose and watery eyes, and can cause serious illness and death. Symptoms usually appear 7 to 14 days after infection.

The bulletin has a warning: “Declining measles, mumps, and rubella (MMR) vaccination rates in Alaska could jeopardize the health of Alaskans.”

Information about Alaska’s lagging childhood vaccination rates comes at a critical time.

Anchorage health officials on May 22 reported the city’s first case of measles in several years. The patient was an unvaccinated child, municipal officials said.

The Anchorage case follows two reported earlier in the year on the Kenai Peninsula, one an adult who had traveled internationally and one a minor, according to the Department of Health.

Unlike the adult Kenai Peninsula case, the sickened Anchorage child had not traveled, said Dr. George Conway, the municipality’s chief medical officer. The child had not had contact with anyone who showed signs of having measles, such as skin rashes, so the source of exposure remains unclear, he said.

But the infected child did spend time at numerous public spaces in Anchorage before being diagnosed on May 21, including a trampoline park and the local YMCA, officials said.

No related measles infections have been reported in Anchorage as of Thursday since this month’s single diagnosis was revealed.

 

Though measles was declared to have been eliminated in the United States in 2000, thanks to the vaccine, the proclamation may have been premature.

Currently, there are large outbreaks elsewhere in the nation, particularly in Texas and neighboring states. There were 1,046 cases and three measles deaths reported nationally as of May 22, according to the CDC. Almost all the cases have been among unvaccinated people, the CDC said.

Conway said the national situation makes the Anchorage case unsurprising. Reduced rates of vaccination around the nation and in Alaska have set up conditions for outbreaks, he said.

“We have a vulnerability and that’s manifesting itself in our susceptibility to cases,” he said. “Alaska is certainly no shining star as far as vaccination rates, but we’re not the worst off, either.”

There are a few states, such as Idaho, that have vaccination rates for kindergarteners that are below Alaska’s rates, according to the CDC. But most states have higher rates for all childhood vaccines.

Conway, who has four decades of experience working in public health, used two words to describe the downward trend in childhood vaccinations: “discouraging” and “disappointing.”

Much of that is the result of misinformation and confusion spread on the internet, including a debunked theory that vaccines cause autism among children, he said. That intensified during the COVID-19 pandemic, he said.

“It’s a much harder environment in which to give advice,” he said.

When it comes to measles, many in the public may underestimate the danger, he added..

“The thing about measles that a lot of people may not understand is it is one of possibly the most readily transmissible respiratory viruses, and it can cause serious illness and deaths,” he said.

The state Department of Health has a similar warning message on its website. “Measles isn’t just a little rash. It’s a highly contagious viral respiratory illness that can be dangerous, especially for babies and young children. Each year around the world, an estimated 10 million people get measles, and about 110,000 of them die from it,” the department warns.

Use of the measles vaccine began in the 1960s. Conway said it is credited with saving 93 million lives worldwide since then.

Health officials hope the news about the Anchorage child who contracted measles – now recovering well – will motivate residents to ensure that they and their children are vaccinated against that and other diseases, Conway said.

However, Anchorage health officials have not noticed any rush toward vaccination yet, he said.

Sarah Aho, the Department of Health’s immunization program manager, said Alaska’s low rate of childhood vaccination is “a multi-faceted situation” that needs a broad-based response.

Disruptions caused by the COVID-19 pandemic were among them, she said by email.

“We saw fewer children vaccinated early in the COVID-pandemic, initially due to fewer kids attending their well-child visits for routine vaccinations in 2020. Many of those kids are now in kindergarten and may have not gotten up-to-date on their routine immunizations,” she said.

A previous report, issued in 2023, also suggested that COVID-related disruptions have resulted in lower vaccination coverage, though for younger children.

Aho, like Conway, also cited bad information leading to mistrust of health science as a factor in reduced vaccination rates. The “increasing prevalence of misinformation might impact vaccine confidence,” she said by email.

Additionally, there are logistical complications in some areas of Alaska, Aho said. “Access to vaccines is a challenge in some communities, further exacerbating barriers of time and potential vaccine availability,” she said.

To address those issues, health officials are developing an Alaska Immunization Coalition and increasing educational efforts, including focused use of postcard reminders, she said.

The Alaska Legislature has approved state funding for child advocacy centers, which support child victims of physical and sexual abuse.

Alaska’s 20 centers were in limbo, facing a $5.5 million shortfall after federal grants were ended or cut, as well as uncertainty over whether operations and services would continue past June.

On Friday afternoon, the budget conference committee – tasked with hammering out the final budget between the House and Senate versions – approved the funds to fill the gap and provide $5.5 million in state funding.

Rep. Andy Josephson, D-Anchorage and chair of the committee, said it was made clear that funding for the centers was a priority. “They’re critically important, and they rose to the very, very top of my list,” he said. “In other words, there was no ask, given their financial predicament and importance, that I thought was more significant.”

Mari Mukai, executive director of the nonprofit Alaska Children’s Alliance, said she was grateful for the funding. The alliance provides support, training and technical assistance to Alaska’s 20 child advocacy centers around the state. “I know what a difficult fiscal situation we’re in right now and understand that many difficult decisions needed to be made,” she said in a phone interview on Monday.

Child advocacy centers provide services for children and their caregivers after suspected physical or sexual abuse, including trauma-informed interviewing, forensic services, streamlined investigations, and victim advocacy through the life of the case. They served 2,061 families statewide last year, Mukai said.

The centers are funded at $10.9 million through a mix of federal and local grants, as well as other funding they raise. Mukai said the state’s backstop funding will make up about half of their budget, and enable the centers to continue current operations and services.

“Unfortunately, Alaska is consistently on the top of the nation for rates of child abuse and violence, and domestic violence, and so unfortunately, yes, I do think that there’s still a lot of need, but this would be a great first step,” she said.

The Alaska Legislature voted to approve the final operating budget on Tuesday, and Gov. Mike Dunleavy will issue budget vetoes of individual line items before July 1.

Mukai added that another federal grant the centers rely on is in danger – the Victims of Crime Act, provided by the U.S. Department of Justice through penalties related to crimes. Alaska advocates are urging the congressional delegation to push the U.S. Congress to protect this funding, as the Trump administration has moved to cancel hundreds of grants and millions of dollars supporting victims services through the Department of Justice.