View Research by Author - Karen Pollitz

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How health care risk is pooled is of defining importance to health care systems. This paper explores provisions in the House and Senate health reform bills that could pool risk across state lines. These provisions include options for states to jointly operate insurance exchanges and enter into interstate health insurance compacts, as well as the development of national health plan offerings. Using available literature and discussions with an array of experts in the fields of health policy, insurance, regulation, and purchasing pools, the paper summarizes the potential for cross-state pooling and the challenges faced in implementation of the specific strategies.

A health insurance exchange can make it possible to organize health insurance markets more efficiently and effectively than takes place today. Because so many different problems must be addressed in the insurance marketplace in order for all to have meaningful and affordable coverage, an entity like an exchange is needed to coordinate tasks and guide markets to comply with consumer protections and compete in cost-efficient ways. While not a panacea for all that ails the health system, carefully designed, an exchange can be a vehicle that facilitates and monitors the movement of the system toward many national health reform goals.

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