MARY LOUISE KELLY, HOST:
Senator Lisa Murkowski was the pivotal vote on President Trump's bill to cut taxes, spend big on border security and slash Medicaid and the Supplemental Nutrition Assistance Program, or SNAP. The Alaska Republican voted for the bill only after extracting special concessions for her state. Alaska Public Media's Liz Ruskin explores how people back home feel about that bargain.
LIZ RUSKIN, BYLINE: Shortly after the bill cleared Congress last week, two dozen protesters gathered on the street outside Senator Murkowski's Anchorage office. Kim Anderson is an anchorage caregiver for Medicaid recipients. She's worried that her clients and family members could lose their health care. She's devastated by Murkowski's vote.
KIM ANDERSON: I flew all the way to D.C. I talked to Murkowski personally. She said she understood, that she was going to fight for us.
RUSKIN: Murkowski declined to speak to us for this story. Right after her vote, she told NBC she made a bad bill better for her constituents.
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LISA MURKOWSKI: But I know. I know that in many parts of the country, there are Americans that are not going to be advantaged by this bill.
RUSKIN: Anchorage Democratic state senator (ph) Genevieve Mina says it's not just people in other parts of the country. She says Alaskans who rely on Medicaid and food assistance are going to be disadvantaged, too.
GENEVIEVE MINA: There's a lot of talk about how there's Alaska carve-outs or Kodiak kickback or a polar bear provision. These were not good deals for the state either.
RUSKIN: Those carve-outs include a two-year delay for Alaska in having to pay a significant portion of their SNAP benefits program. The bill also has niche tax law changes benefiting Alaska whaling captains and a few nonprofit fishing companies, and it requires the federal government to offer millions of acres in the Arctic for oil lease sales. These have been priorities of Murkowski's for a long time. Maybe the biggest win Murkowski negotiated was boosting a fund for rural health care to $50 billion.
JARED KOSIN: I don't want to sound ungrateful because, you know, that's better than the alternative.
RUSKIN: Alaska Hospital and Healthcare Association president Jared Kosin says it's impossible to know how much of that $50 billion Alaska will get. Meanwhile, he expects some 34,000 Alaskans will lose Medicaid coverage. That's an extrapolation from an earlier nationwide estimate from the Congressional Budget Office. Kosin says many will resort to emergency rooms when they need health care.
KOSIN: And they're going to show up at our facilities, and we're going to do our best to take care of them. But at the end of the day, that is a terrible model of health care in our state and any other state.
RUSKIN: Murkowski long ago alienated Alaska's conservatives, but some are impressed with her now. John Coghill is a former Republican state senator and ran a faith-based homeless shelter in Fairbanks. He likes the bill because he thinks federal social programs need to be reformed. He says some of the exceptions Murkowski got for Alaska he wouldn't have asked for.
JOHN COGHILL: But she did, and she did it with all of her heart. So in some regards, I respect her a lot for that.
RUSKIN: Coghill says Murkowski probably couldn't have stopped the bill. He thinks Republican Senate leaders would have just negotiated with another holdout instead.
For NPR News, I'm Liz Ruskin in Anchorage. Transcript provided by NPR, Copyright NPR.
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