RWJF/UI-Multi-State Health Insurance Exchanges

The ACA allows two or more states to come together and create a health insurance exchange. This brief examines why states might consider a multi-state exchange and the issues surrounding doing so.

The author finds four justifications for creating a multi-state exchange:

• Administrative economies of scale could be significant
• Regional exchanges might make sense in large metropolitan areas that cross state boundaries
• Multi-state exchanges could promote pooling across state lines
• Multi-state exchanges could create the critical mass of insured persons to stabilize risk pools in low-population states.