Those looking for an explanation for the cost of health insurance in Alaska might focus their attention on the astronomical cost of health care in Alaska.  Health insurance is expensive because health care is expensive, and we have the most expensive care delivery system in the country.  The ACA did not cause that, (though it may have forced the issue by putting some expensive patients in the pool that previously were uninsured).   Yet, the same people who complain about insurance costs scream bloody murder when any effort is made at cost containment.