Sen. Dan Sullivan is staring down a reelection race in Alaska where healthcare costs and lapsed ObamaCare subsidies have become the central line of attack, and where his own recent votes suggest he knows it.
The Republican senator, who has broken with his party twice in the past month to side with Senate Democrats on health-related amendments, now faces a Democratic ad campaign accusing him of voting to raise health insurance premiums by more than $1,800 on average for Alaskans. Former Rep. Mary Peltola, who launched her Senate campaign earlier this year, leads Sullivan by nearly seven percentage points in a late April poll conducted by Alaska Survey Research.
The numbers tell a clear story about Alaska's healthcare landscape. About 3,000 Alaskans dropped out of the ACA marketplace after enhanced subsidies expired, an 11 percent decrease, according to initial figures from the Centers for Medicare and Medicaid Services. The Commonwealth Fund's 2025 Scorecard on State Health System Performance ranked Alaska 38th out of 50 states. And Premera Blue Cross Blue Shield of Alaska controls more than 70 percent of the state's active insurance market, leaving consumers with few alternatives when premiums climb.
Sullivan voted for an amendment sponsored by Senate Minority Leader Chuck Schumer opposing any funding bill that failed to lower out-of-pocket healthcare costs. He also voted for an amendment from Sen. Jon Ossoff of Georgia aimed at addressing insurers who delay or deny care. Late last year, Sullivan was one of just four Republican senators who voted to extend the ObamaCare tax credits, after previously voting against similar measures. That extension failed to reach the 60-vote threshold needed to pass.
His office defended the record in a statement, pointing to Sullivan's "track record of voting with colleagues on both sides of the aisle when it's good for Alaska."
"While he remains a vocal critic of Democrat one-size-fits-all federal policies that have historically crashed Alaska's insurance market, Sullivan repeatedly voted to extend the ACA enhanced subsidies to protect everyday Alaskans from the cliff Democrats imposed when they allowed the subsidies to expire in 2025."
Sullivan's office also said one of his priorities is "getting healthcare dollars out of the hands of insurance companies and into the hands of the people." He has argued that some of his own efforts to protect healthcare for Alaskans, including an amendment to the One Big Beautiful Bill Act, were defeated by Democrats.
That framing has not convinced everyone. The broader dynamic in the Senate heading into 2026 involves both parties jockeying for advantage on pocketbook issues, and Sullivan's pivot has given critics ammunition from an unexpected angle.
Scott Leitz, vice president of the healthcare programs department at NORC at the University of Chicago, described the structural factors that make Alaska especially vulnerable to federal policy shifts.
"The biggest sort of defining factor in really understanding the economics of healthcare there is it's a really, really big state, but it's also highly dispersed in terms of its population. So, all of that kind of combines up into creating an environment where costs are somewhat higher and access to care can be more of a challenge than in some of the more highly concentrated population states."
Leitz also noted Alaska's unusually high concentration of federal employees, estimated at 6.6 percent of the workforce in 2024. That makes the state disproportionately sensitive to changes at the federal level, a dynamic that extends well beyond healthcare. Recent federal personnel decisions from the White House have underscored how much Alaska's economy depends on Washington's payroll and policy choices.
Sara Collins, a senior scholar at the Commonwealth Fund, laid out the financial stakes in blunt terms.
"Alaska is facing a loss of a lot of federal funding because of the [cuts to] Medicaid through the HR.1 legislation last year and then also the expiration of the premium tax credits, and it adds up to quite a lot of money in terms of funding losses."
Collins added that the effects extend beyond coverage numbers. "It also has trickle-down effects for the broader economy," she said, noting that Medicaid dollars and premium tax credits "support coverage, but it also just supports the overall health system and the state."
Peltola's campaign announcement took direct aim at Sullivan's support for the GOP megabill, citing a think tank projection that it would strip healthcare coverage from millions of Americans. A Democratic ad campaign released late last month hammered the premium-increase angle. The message is straightforward: Sullivan voted the party line when it mattered, and Alaskans are paying for it.
John-Henry Heckendorn, a partner at the Ship Creek Group, a cross-partisan campaign management firm that worked on Peltola's first House campaign but is not involved in her Senate bid, said the political damage may already be done.
"Given how many times he has voted for legislation or amendments that would either reduce healthcare subsidies for Alaskans or otherwise increase healthcare costs, the damage has largely been done."
Heckendorn called healthcare "absolutely" an issue that could sway Alaskan voters, citing the state's sky-high costs.
"We have some of the highest healthcare costs in the country, and our marketplace has, I believe, some of the most expensive premiums. And there's some studies that show that healthcare costs for Alaskans have increased by over $1,000 in the last year."
But Heckendorn's sharpest point cut at the timing of Sullivan's cross-aisle votes. Democrats have their own leadership headaches to manage, Schumer's recruitment efforts have stumbled elsewhere, and the question of whether Sullivan's recent moves reflect conviction or calculation is one both parties will try to answer for voters.
"It's one thing to vote on your principles. It's another thing to follow the party line until you feel like you're in danger and then try to cover your tracks. Alaskans can't get the dollars back in their wallets that they've had to spend on inflated healthcare costs as a result of his votes. All that damage is done, but now he's kind of admitting that those votes were never about principle in the first place."
Sullivan's predicament is not unique to him. Across the country, Republicans who supported the One Big Beautiful Bill Act and related spending measures are being forced to defend the downstream effects on healthcare in their home states. But Alaska's geography, its thin insurance market, and its reliance on federal dollars make the issue especially acute.
The senator's office has offered a substantive defense: he voted repeatedly to extend the subsidies, he pushed amendments that Democrats blocked, and he has consistently worked to redirect healthcare spending away from insurance companies and toward patients. Those are real votes on the record.
The counterargument is equally concrete. Sullivan voted with his party on the broader legislation that set the cuts in motion. He shifted on the subsidy extensions only after previously opposing them. And the results, higher premiums, fewer marketplace enrollees, a state ranking near the bottom in healthcare performance, are landing on Alaskan families right now. The broader pattern of Washington timing its announcements to political calendars is something voters have learned to recognize.
Six months out from Election Day, the race is competitive. Peltola's early polling lead is real but narrow in a state that has surprised both parties before. Healthcare is the issue Democrats want to run on, and the facts on the ground in Alaska give them material to work with.
Sullivan's task is to convince voters that his recent votes reflect genuine priorities, not a foxhole conversion. In a state where premiums are among the highest in the nation and 3,000 people have already walked away from the marketplace, that argument will have to be made with more than floor speeches.
Voters tend to forgive a lot from their senators. But they remember what things cost, and in Alaska, healthcare costs more than almost anywhere else in America.
