VIII. Safer Communities 

The same commitment to keep security that protects Alaska on the world stage must also be made to protect Alaskans in their homes and neighborhoods.

Crime rates are going down, as the Governor mentioned in his “State of the State” to all of you in many communities. But we can’t be complacent. Protecting our children, confronting addiction and mental health challenges, and keeping all communities throughout our state safe requires standing firmly with law enforcement and giving them our full support.

Nowhere have the stakes been higher in confronting the crime crisis in our state than in confronting the fentanyl crisis. Alaska has experienced the highest increase in fentanyl overdose rates in the nation for the past three years. We lost 400 young Alaskans just last year alone. Fentanyl is now responsible for more than two-thirds of all fatal overdoses in our state. These are our sons and daughters, brothers and sisters, nieces and nephews. They are our neighbors! I guarantee you, there’s not one member of the Legislature that doesn’t know someone who’s been impacted by this. These kids were our future! No longer.

Much of this poison was smuggled across the southern border, some across the northern border, reaching even our most remote villages in our state.

But we’re cracking down. The open border policies of the Biden administration are fortunately a thing of the past. When the Trump administration returned to office, illegal border crossings have dropped by 99 percent. For 8 consecutive months, zero illegal immigrants have been released into the country. The Working Families Tax Cuts Act included $100 billion to secure the southern border and give our law enforcement the tools they needed to disrupt cartels, stop fentanyl before it reaches our towns and villages, and protect families and save lives. That’s the supply side of the challenge.

There’s also the demand side that we need to work on. This is something my team and I have been very focused on. If you take a look at one of these handouts, our One Pill Can Kill campaign. Some of you have helped me spread the word on this. My team and I have been working to get out to the schools, get out to the high schools, the junior high [schools], and just talk to the kids about how dangerous this is. We all need to continue to do that, because these young kids are our future. Losing 400 a year is simply unacceptable.

IX. Fisheries

We’ve also worked tirelessly to help our fishermen and coastal communities. As the chairman of the subcommittee with jurisdiction over fisheries, my team and I work on this issue relentlessly.

I have a handout here that goes through all the different areas in which we’re focused on fisheries for our state. This is something, again, we can work together on.

My Save Our Seas Act legislation, the first one, the 2.0 one—we’ve had amendments to it—is still the most comprehensive ocean clean-up legislation ever passed by Congress. We continue to be focused on that.

We continue to confront the unfair global seafood trade practices that undercut Alaska fishermen and our communities. My team and I have worked very hard over years to secure the ban on Russian seafood trawlers. So there’s no Russian seafood coming into America. When we got that done, they started sending it to China, literally to launder the fish through China. We shut that loophole down, and we will continue to push for stronger international coordination.

So the bad actors, like Russia and China—who, by the way, use slave labor on their ships, who have the worst environmental standards in the world, who ravage the high seas and distort seafood markets and really hurt our coastal communities—this is something we are very focused on continuing.

As I’ve been saying in many forums, we need to eat, and encourage Americans to eat, Alaskan “Freedom Fish,” not Russian and Chinese “communist fish.”

But we still have a lot of work to do. I passed the Alaska Salmon Task Force Act to bring together the best minds in the state—federal, tribal, university, Native, indigenous—all to come together, experts in our state, to understand and address the declines in Alaska salmon runs. We’ve had this great variability of salmon runs, some very strong, like in Bristol Bay. Others on the Yukon and Kuskokwim, and in Southeast, have been historically low.

Last year, I introduced the next phase of this comprehensive salmon focused legislation called the “Bycatch Reduction and Research Act” to close remaining knowledge gaps through tools like adult salmon tagging, faster genetic analysis of bycatch, and new technologies and policies to reduce bycatch and protect marine habitats.

I know you are all focused on these issues as well, and you have my commitment to continue working closely with this body on these critical issues.

X. Health Care

I want to end my remarks with the focus on one of Alaska’s greatest challenges, and that’s affordable health care.

Health care costs remain stubbornly high. Like so many one-size-fits-all programs designed in D.C., Obamacare failed our state. The law crashed Alaska’s health insurance market, dropping us from four insurers before Obamacare was enacted, to only one, eventually, leaving us now with just two. Premiums for Alaskans in the individual market skyrocketed to the highest anywhere in America. Insurance companies got rich, and Alaskans paid the price.

I’m still working with a bipartisan group of senators on a reform package to extend premium tax credits, after starting to vote to extend them in December of last year. We’ve also made progress—important progress, even historic progress—in bringing down the costs of prescription drugs for Alaskans, pairing long overdue PBM reform that we just passed last fall to rein in middlemen who have been driving up the costs of drugs, with our work to ensure that Americans no longer pay more than developed nations for the same medicines. This is what you call “most favored nation status,” which we are now working on. It’s very important.

But a new strategic approach on how federal funds are allocated and delivered to states with regard to health care has been needed for years.

For far too long, when it came to federal health care funding, Alaska was consistently left behind. Despite being the most rural state in America, and among the [costliest] places in our country to deliver health care, we received fewer federal health care dollars per capita than any other state, particularly when it comes to federal Medicaid, or what’s called the Medicaid match.

I’m sure you’re all familiar with that. The “FMAP” as they call it. Our state, when I first got to the Senate, had the lowest federal match of any state in the country for Medicaid: 50/50. We’re now at about 51/49, still one of the lowest.

To make matters worse, Alaska is the only state in the country that does not use these kinds of schemes they call “provider taxes” or “state-directed payments,” mechanisms used by states to inflate their federal Medicaid reimbursements, sometimes by hundreds of millions of dollars each year. This was not a failure of Alaska. This was a failure of the entire system.

Bringing federal health care funding to Alaska that actually reflects our challenges has been one of my top priorities since I joined the U.S. Senate. When we were debating the Working Families Tax Cuts Act, my team and I pushed very hard to include a provision that would correct this broken FMAP formula for Alaska. It would increase Alaska’s federal match amount up to 65 percent, or about $200 million annually from Medicaid to our state.

That has been something I’ve been working on for years, because I thought it was fair. I went to the White House. I went all the way to the President to pitch this. I went to all my Senate colleagues, Republican colleagues, to fix this Alaska unfair situation. I got them all on board. I got this provision in the bill.

But, on the one-yard line, as we were debating this bill late at night in the final stages of the process on this bill, Senate Democrats, led by their leader, Chuck Schumer, challenged in front of the parliamentarian—that you can do under budget reconciliation—this Alaska FMAP provision to try to get it stripped out of the bill.

We went in and we fought them. This is kind of like a court of law. You argue your case in front of the parliamentarian. Unfortunately, they prevailed. So after nearly a decade of work on this pro-Alaska bill, in the middle of the night, it was stripped out, and it was a gut punch. It was a gut punch. I had been working on this for a long time, and it was fair. It was the right thing to do. But we pivoted. We weren’t going to take that defeat lying down.

Although our Alaska FMAP enhancement was stripped out, another program remained in the bill. That was the Rural Health Transformation Program in the Working Families Tax Cuts Act.

Originally, a total of $25 billion for the whole country. My team and I—we got good cooperation from the White House and Senate Republicans, because they just saw how Alaska got screwed by our FMAP being taken out of the bill. We said, “Let’s double it from $25 to 50 billion.” If we could not fix Alaska’s FMAP immediately, we could reshape this bill to better benefit Alaska, which is what we did.

We doubled the size of that fund. We made it start in 2026 as opposed to 2028. We secured a $100 million base amount for every state in the country, not per capita, just a base amount, which of course, you know, is great for our state. Most importantly, we rewrote the formula of that bill to ensure our whole state was considered rural as it relates to this bill.

Now, I’m sure you’ve all seen our state will receive—from this fund—approximately $1.4 billion over the next five years to transform our health care system.

Take a look at the handout here. It has a lot of the provisions of it. Only Texas, which has a population 40 times bigger than ours, received a larger award. This is the biggest federal investment in Alaska health care history. Now, it’s up to us to take advantage of this historic opportunity on health care. By the way, I appreciated the good discussion I had with a number of you on this yesterday, how to seize this opportunity.

To be clear, more federal dollars alone do not automatically produce better health care outcomes. But targeted, thoughtful investments paired with accountability can be transformative. Someone asked me last year whether I could commit to protecting Social Security, Medicare, and Medicaid when I gave these remarks last year. Let me be clear: The Working Families Tax Cuts Act doesn’t touch Social Security, regardless of what you’ve seen in terms of ads on TV.

In fact, the Working Families Tax Cuts Act, as already mentioned, delivers a $6,000 tax break for each senior. You combine that with our passage of the Social Security Fairness Act last year, our seniors and retirees across Alaska, including our heroic teachers and firefighters, are going to have thousands of dollars more in their pockets.

The bill does not touch Medicare. In fact, it strengthens Medicare by including what’s called a “doc fix,” which ensures Medicare patients will continue to be able to get the help they need from their doctor.

Finally, the bill does not touch Medicaid for Alaska. It is protected. The bill does not cut one dollar of Medicaid funding to our state. If we’re going to talk honestly about Medicaid cuts, the only party that actually succeeded in cutting Medicaid funding as we wrote and debated the Working Families Tax Cuts Act, were Senate Democrats and Schumer as they stripped out the FMAP provision of our bill, cutting about $200 million a year of Medicaid funding to Alaska. That is a fact.

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