The authors simulate the effect of the Affordable Care Act (ACA) in Alaska, both with and without the Medicaid expansion. The ACA would reduce the uninsured rate in Alaska from 21% without the ACA to 10% under the ACA with the expansion, or 15% without the expansion. The Medicaid expansion would increase enrollment 30% by 2020, while state Medicaid spending on the nonelderly would only increase 3.7%. The report includes a sensitivity analysis of Medicaid take-up rates and detailed characteristics of new enrollees by sub-state region.