Nick Begich III voted for a law that pulls $911 billion of federal Medicaid funding over ten years. He is Alaska's only House member. His yes on May 22, 2025 supplied a deciding vote when the House version cleared 215 to 214. His second yes, on July 3, 2025, came as the final law passed 218 to 214. Alaska's share of the Medicaid loss is $2.015 billion, KFF calculates.
Months earlier, the 2025 budget resolution passed twice on Begich's deciding votes. That plan set the House committee in charge of Medicaid a savings target of at least $880 billion. Medicaid covered 210,400 Alaskans in 2025, 29% of the state.
Nick Begich III's Votes on Medicaid
- Begich Voted Twice for the Law That Cuts Medicaid by $911 Billion. Nick Begich III voted for H.R. 1, the One Big Beautiful Bill Act, at the May 22, 2025 House vote. The count was 215 to 214, with one member present. A no from Begich would have sunk it. He voted yes again on the final law on July 3, 2025. That count was 218 to 214. By the Congressional Budget Office's estimate, Medicaid loses $911 billion in federal funds across ten years. The same office expects 10 million more Americans without insurance by 2034. KFF's state split charges Alaska $2.015 billion, or 11% of its expected federal Medicaid funding.
- Begich's Votes Decided the Budget Plan That Set Medicaid's Committee an $880 Billion Savings Target. Begich said yes to H.Con.Res. 14, the budget resolution, on February 25, 2025; the tally was 217 to 215. He said yes again to the final version on April 10, 2025; that tally was 216 to 214. Had Begich alone flipped, each would have ended in a tie, and ties lose. The resolution instructed Energy and Commerce to "reduce the deficit by not less than $880,000,000,000". Begich also voted for the May 22 rule for debating H.R. 1. The Medicaid cuts came in the final law Begich voted for on July 3. One limits provider taxes, a main way states raise their Medicaid share. That limit by itself costs Medicaid $191 billion over ten years, the Congressional Budget Office says. A second caps the extra payments states route to hospitals. KFF found that "payment rates for hospital services will decrease in at least 37 states" under it, starting in 2028.
What Nick Begich III's Medicaid Votes Mean for Alaska
- 210,400 Alaskans depend on the Medicaid money the law shrinks. Alaska's at-large district had 210,400 people on Medicaid in 2025, KFF data show, 29% of everyone in the state. That count includes 72,100 children, 13,500 seniors and 11,500 people with disabilities. It also includes 65,500 adults who qualify through the expansion. Federal Medicaid dollars, which the law reduces, pay much of their care.
- As many as 13,611 Alaskans stand to lose Medicaid over the work rule. The state counted 61,169 expansion enrollees ages 19 to 64 for its February 2026 model. Of those, 18,905 would have to file paperwork to stay covered, the Alaska health department estimates. Its two scenarios show 9,452 or 13,611 people dropped. The requirement hits Alaska expansion adults in January 2027.
- The law leaves 25,000 more Alaskans uninsured in 2034. On its own, the law raises Alaska's uninsured count by 25,000 in 2034, KFF projects, lifting the uninsured rate 3 points: 25,000 Alaskans who would otherwise have coverage go without it.
- Rural Alaska gives up $824 million in Medicaid funds. Over ten years, rural Alaska's federal Medicaid funding drops by $824 million, by KFF's math. Rural clinics and hospitals bill Medicaid for that care.
Frequently Asked Questions About Nick Begich III on Health Care
What is Nick Begich III's record on health care under Trump?
Nick Begich III cast House votes of May 22 and July 3, 2025, for the One Big Beautiful Bill Act; the first was decisive, and the final law passed 218 to 214. That law takes $911 billion from federal Medicaid over a decade, and Alaska's share is $2.015 billion. Begich also cast deciding votes for the 2025 budget resolution that set the $880 billion savings target behind the Medicaid cuts. KFF projects 25,000 more uninsured Alaskans in 2034 because of the law.
Did Nick Begich III vote to make Alaska Medicaid enrollees prove they work?
Yes. On July 3, 2025, Nick Begich III voted for the law that sets the rule. Expansion adults must log at least 80 hours a month of a job, volunteering, a work program or school. States must also recheck their eligibility "once every 6 months". Alaska expansion adults face the rule starting in January 2027.
Did Nick Begich III vote to shorten Medicaid's retroactive coverage?
Yes. Nick Begich III voted for the final law, which cuts how far back Medicaid will pay for care a patient got before applying. Prior law reached back up to 90 days. Starting January 1, 2027, it is one month for expansion adults and two months for everyone else, so an Alaskan who applies after a hospital stay can be stuck with bills Medicaid once paid.
Last updated: 2026-10-27