I think part of it is while Alaska did finally expand medicaid Alaska as a Republican state never embraced the federal mandate of the ACA and in fact our representatives and govenor-at the time worked against it. Subsidies were available the first year but after that and the fact that many Alaskans had been convinced the ACA was evil and were against it the subsidies were discontinued(for not following the mandate) Other red states have the same dilemna(OHIO). Even recently Rep. Don Young also voted for the now infamous Republican plan to gut medicaid. I hope Alaska does get it together before its too late. Alaska could have been and should have been a shining star for healthcare a long time ago if only big business and the powers that be hadn't convinced the rest of us it could never be done.