"Right, but most plans I think have somewhat reasonable copays/coinsurance for ER visits,"

That's true but watch out because insurance plans are finding ways to move more than those copays/coinsurance costs onto patients, even for ER care. It is in how they are applying deductibles and maximum out-of-pocket payments when providers are not "in-network." Very few providers in Alaska belong to a single network, and insurance plans can (some already are) refuse to apply the balance-billed amounts (which in Alaska is the majority of the cost) to any deductible or the max out-of-pocket. Also, their "allowed" reimbursement amounts are a pittance of what providers charge, and what portion of co-insurance a patient pays on that allowed amount will go to the much higher out-of-network deductible, not the in-network. An ER visit or sudden urgent procedure can be financially devastating.

There's also care for chronic conditions to consider. They might not fit a twice a year to Seattle model.