Alaskans who purchase insurance through the ACA marketplace (including my wife and me) are hit with a double-whammy: 1. Health care costs in Alaska are very high, and 2. The risk pool over which these costs are spread is very small. This bill is good in that it spreads the high costs that some patients incur over a larger population.  However, it would be even better if the 23,000 or so patients in the ACA market could join larger pools.  Remember, the way you drive down medical costs is by combining as many patients as possible into one single pool, and then that pool of patients will have more bargaining power when negotiating cost of care from physicians, medical centers, pharmaceutical firms, etc.  Almost every other developed nation has single payer plans like that, and that is why their health care is so much less expensive and of equal or better quality than here.