A new report from the Urban Institute examines reasons for two or more states to consider combining resources to create a multi-state health insurance exchange under the health care reform law.

The report explains four rationales for multi-state exchanges; administrative economies of scale, better service of large metropolitan areas that cross state lines, promoting pooling across state lines, and creating a critical mass of insured persons to stabilize risk pools in low-population states.

One scenario that likely won't play out is cross-state risk sharing, as that could lead to one state's population effectively subsidizing another state's population, the report concludes. The report, funded by the Robert Wood Johnson Foundation, is available here.

--Joseph Goedert


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