The Cadillac tax issue exists because health care costs are so high in Alaska, driving up the cost of health insurance premiums. Another big problem concerns those people who have to buy health insurance on their own (i.e. they don't get it through an employer) but earn more than 400% of the poverty level. They don't get subsidies and must pay huge premiums. No matter what is done at the national level, our local health care costs have to be brought under control.