OPINION: The form that takes away your health care

Dan Sullivan and Nick Begich voted to make Medicaid coverage conditional on proving, month after month, that a recipient has met a government work requirement. Beginning in 2027, under the One Big Beautiful Bill Act, certain adults covered through Medicaid expansion will have to document 80 hours a month of work, a work program, community service or half-time school enrollment, or risk losing coverage. The justification is familiar: taxpayers should not support people who could be working. That principle evaporates when the spending in question is compared with a war, a ballroom or a presidential monument. Many working-age Medicaid recipients already work, study, care for relatives or piece together seasonal jobs. In Alaska, fishing, tourism and construction run on weather, not calendars. Rural Alaskans may travel hours by boat or plane to reach a clinic or government office, while unreliable broadband can turn a simple reporting requirement into an obstacle course. Eighty hours sounds manageable to someone with a steady job and reliable internet. It sounds like a trap to someone without either. The mandate will not create child care, cure illness or fix rural transportation. It will create another bureaucratic test and add administrative costs for both recipients and the state. Arkansas already ran this experiment. After imposing a Medicaid work and reporting requirement in 2018, Arkansas saw more than 18,000 people lose Medicaid coverage. Researchers found no significant increase in employment and concluded that reporting and administrative barriers were major reasons people lost coverage. Congress knew that history. Sullivan and Begich voted for the national version anyway. Now apply the same standard to Washington. Defense Secretary Pete Hegseth said in July that the Iran war had already cost $37.5 billion. The administration has also requested roughly $67 billion in additional military funding. Meanwhile, the administration is building a massive White House ballroom to serve the elite. The Washington Post reported project's March estimate at $600 million, with more than half expected to come from taxpayers, despite President Trump's repeated claims that private donors would pay the cost. And a triumphal arch Trump proposed, which Axios reported could cost as much as $100 million, would add to the administration's spending. That is not fiscal discipline. It is debt-expanding spending for the rich paired with selective austerity for the less fortunate. A Medicaid recipient must document that they worked, studied or otherwise qualified. Washington faces no comparable requirement to prove that a $37.5 billion war is worth the cost, that a $600 million presidential ballroom is necessary, or that a $100 million monument deserves priority. To be fair, Sullivan and Murkowski pushed for Alaska-specific relief, though the Senate parliamentarian struck key Medicaid provisions. The exemptions that remain, for Alaska Natives, high-unemployment areas, seasonal workers and delayed implementation, are rules that benefit Alaska. Alaska Natives are exempt from the Medicaid work requirement, and Alaska may request a hardship exemption for people living in areas the state designates as having high unemployment. The state also has flexibility to account for Alaska's seasonal economy and can delay implementation while building its reporting system. That work deserves credit. But exemptions on paper are not the same as access in practice. State-commissioned modeling estimates that roughly 9,400 to 13,600 Alaska Medicaid recipients could lose coverage under the new rules. That is why implementation matters. Alaska needs automatic exemptions when state records already establish eligibility, paper and telephone reporting for communities without reliable broadband, plain-language notices and an appeals process that catches bureaucratic errors before they cost someone coverage. Sullivan cannot guarantee Alaskans that those protections will work. Begich supported the same legislation and has defended its Alaska exemptions. Accountability cannot run in one direction. If Washington can demand that a Medicaid recipient document 80 hours of work every month to keep a doctor's appointment, Washington should be able to document why $37.5 billion for a war is necessary, why hundreds of millions of taxpayer dollars belong in a presidential ballroom, and why another $100 million should be spent on a monument to presidential ambition. The poor get a form. The powerful get a blank check. That is not fiscal responsibility. It is a double standard: the people who can least afford to lose their health care face strict accountability, while Washington's biggest spending decisions face far less or no scrutiny at all. A form should never be the price of seeing a doctor. Van Abbott is a 36-year resident of Alaska having worked in Ketchikan, Fairbanks and Anchorage as a municipal, financial and utility manager. He resides in Ketchikan and is currently a freelance writer. He served as a Peace Corps teacher in the 1960s. See his website: politicalwinds.org.