In the face of all this talk about providing insurance to those who have pre-existing conditions or who otherwise are denied health care coverage, the Alaska Comprehensive Health Insurance Association has been on the airwaves, on Web sites and in print, telling Alaskans that it provides "hope for Alaska's hard-to-insure."

Hope indeed, if you can afford it. ACHIA is a nonprofit group of insurers which, under state mandate, provides partially state and federal government-subsidized policies for about 560 Alaskans who have lost their insurance, or who were denied insurance because of pre-existing conditions like diabetes or a heart condition. It's priced at about 135 percent of what a similar policy would cost in the marketplace, says Cecil Bykerk, executive director of the program, which in Alaska means it's prohibitively expensive.

A 40-year-old male buying insurance through the program with a $1,000 deductible currently pays a whopping $985 a month, not including vision or dental coverage. The copay is 20 percent, with no out-of-pocket limit, and doesn't include routine physicals and preventative care.

In Arkansas roughly the same kind of coverage costs $282 a month, and in Iowa, $376. Wyoming: $448 a month. In Idaho, if you make more than 250 percent of the poverty level, it's $417 a month. If you make less than that you'll pay $358.

Bykerk understands how pricey this insurance is, but he says at least it's helping some people. And, he notes, all health care insurance is expensive in Alaska. Indeed, even for those who are healthy and who get private insurance, or those who are covered under their employers, health insurance premiums for Alaskans rose 90.8 percent between 2000 and 2009 while earnings rose by 17.3 percent according to Families USA, a nonpartisan and nonprofit health care advocacy group.

The cost of insurance is directly tied to the cost of medical care, said Bykerk. However, the answer to why Alaska's medical care is so costly is one that for years has eluded those who have asked the question. Some say it's because we're unhealthy compared to other states. Others believe it's because the pool -- the number of people we insure -- is so small. Still others claim the state provides little oversight of the medical industry, leading to high prices. Doctors continue to charge more, and the two insurance companies that dominate Alaska's health insurance market -- Premera Blue Cross and Aetna -- have an interest in keeping doctors happy; therefore, they reimburse what the doctor charges. And those costs get passed down to the consumers.

Eric Earling, spokesman for Premera Blue Cross, says that's an oversimplification of a complex issue.  He says that, among other things, doctor shortages play a role. But he does say that Premera is "very aware of the need to address the issue of ever-rising medical costs.  In Alaska, that does mean a particular attention to physician costs."

What are those costs? It's nearly impossible to find out what doctors charge for what procedures, particularly with surgical procedures. But a report recently issued by Alaska's Health Care Commission provides some startling numbers.

The report compares costs for those insured under Medicaid (a federal and state government-funded, low-income insurance program) in Alaska to those same procedures billed under Medicaid in Washington state. It found that reimbursement rates in Alaska were up to 192 percent of what they are for the same services in Washington. In Alaska, doctors get reimbursed $1,141.23 for cataract surgery, to name just one procedure. In Washington, it's $394.44.