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Taking away $1 trillion in healthcare, giving back $50 billion in project grants
As Trump and supporters tout series of RHTP awards in Alaska and elsewhere, critics say they don’t help now-uninsured people when they break a leg
By Mark Sabbatini
Juneau Independent
One set of headlines is dire warnings about millions of people losing health insurance and hospitals closing due to a $1 trillion cut in federal health spending during the next decade. The other is a steady stream of upbeat announcements about projects getting funding during the next five years from the $50 billion Rural Health Transformation Program.
A total of $249 million in RHTP funds for 254 projects in Alaska was announced Thursday by the Trump administration, including portable X-ray units and cellular-enabled remote monitoring of people with chronic conditions for villages in the northern part of the state.
Also recently announced for Juneau are several RHTP projects including $3.6 million to transfer the largely empty St. Ann’s building into a senior care center and $215,000 toward a childcare center for Bartlett Regional Hospital employees. A total of $272 million was allocated for Alaska during the first year of the program, part of roughly $1.4 billion for the state over five years.
"The Rural Health Transformation Program is expanding access to quality healthcare, regardless of a patient’s ZIP code, while equipping first responders with the lifesaving resources they need when every second counts," a press release issued by the U.S. Department of Health and Human Services on Thursday states. "This funding will make critical investments to strengthen rural healthcare, expand access to lifesaving services, and bring modern technology to communities across Alaska."
Such projects can be helpful, but they can’t replace 34,000 Alaskans who’ve lost health insurance since last year and average premium increases of 346% for residents who lost enhanced subsidies under the Affordable Care Act, said two Juneau state lawmakers during a press conference last week. The conference focused on cost concerns to patients and medical facilities.
"It's not going to change what happens when you break your leg, it just doesn't," said Sen. Jesse Kiehl, D-Juneau. "It's got nothing at all to do with the cost of labor and delivery. That's not a function that is impacted by what this Rural Health Transformation Program can pay for."
State Rep. Sara Hannan, D-Juneau, said RHTP projects "may reduce some health risks on down the road, but for the people who already have health needs it's not going to help them get their health needs done."
RHTP funds can be used for projects such as improving existing facilities (but not building new ones), technological advancements, assessing ways to more efficiently provide services and community efforts such as farm-to-hospital food programs. The money cannot be used to duplicate or replace personal health insurance, Medicare, or Medicaid coverage.
Bartlett Regional Hospital could lose up to $4 million annually in lost Medicaid revenue due to the cuts passed in the 2025 federal budget bill, according to CEO Joe Wanner. He also stated in May that 200 to 400 Juneau residents are expected to lose health insurance because of the cutback in Affordable Health Care Act (ACA) subsidies.
The $1 trillion in health coverage cuts over a decade and $50 billion in RHTP over five years don’t represent every cut or addition to federal healthcare spending during the coming years. But they are what policymakers are largely referencing while debating the health insurance and medical treatment impacts of spending passed during President Donald Trump’s second term.
During a debate last week between the two leading candidates in Alaska’s U.S. House race, independent challenger Bill Hill asked incumbent Republican Nick Begich III about a conversation with a mother in Southeast Alaska.
"She was paying just over $400 a month for healthcare," Hill said. "She had a growing family, bunch of young kids. She lost the ACA tax credits. She was faced with over a $3,000 a month bill. What do you say to her?"
Begich responded by claiming high levels of fraud in the ACA program — a common focus of Republican candidates nationwide this election cycle — and stating "I am supportive of extending support for people who need it."
"That's why we invested over $1 billion over the next five years in Alaskan healthcare in our rural communities," he said, switching the focus from ACA to RHTP. "It’s so important to make sure that people have access to effective, efficient care."
A similar exchange between the two leading candidates in Alaska’s U.S. Senate race occurred a day later. Incumbent Republican Dan Sullivan responded to a question about thousands of Alaskans losing insurance by stating RHTP will provide "$1.4 billion to transform Alaska's healthcare system, which is a great opportunity for all of us."
Modern healthcare costs outpaced inflation for decades before the current Trump administration's policies were enacted. The New York Times reported Wednesday one year of health insurance for a family plan in 1987 cost an average of $7,058 (adjusted for inflation) compared to $26,993 in 2025. Experts cite a range of factors such as technology advances, an aging population, and employers and insurance companies shifting more costs onto individuals.
Age plays a major role in health insurance rates, with older people in particular facing "skyrocketing costs," the finance magazine Kiplinger reported in May. That gap is expected to widen with the cuts imposed by last year’s budget bill.
Silver-plan health insurance coverage in 2027 would cost about 16% of the after-tax pay for a 30-year-old person making $60,000 a year and about 38% of take-home pay for a 60-year-old person making the same amount, according to estimates provided in the article. A further search shows gold-plan coverage would cost more than 50% of the latter person’s after-tax salary.
• Contact Mark Sabbatini at editor@juneauindependent.com or 907-957-2306.
