Having employers join together to purchase health
insurance is an idea that continues to have broad
appeal. The concept is the foundation of several
proposals now before Congress, and several state
legislatures have recently passed laws to implement
the idea, joining a number of others with laws already
on the books. Pooled purchasing arrangements are a
major element in a significant proportion of 17
coverage expansion proposals recently prepared for
the Covering America project by nationally known
health analysts and researchers. And the concept has actually been implemented in a variety of guisesacross the country in the last several decades. The
long-standing interest in pooled purchasing suggests
that the idea deserves careful attention.

The purpose of this paper is to explore the functions and structure of pooled purchasing arrangements in the
context of a particular approach to expanding health
insurance coverage to the uninsured — namely, an
approach formed around an individual mandate and
federal tax credits. Before turning to the main topic of
pooled purchasing, however, we lay out the principles
or underlying values that justify this particular
approach to coverage expansion.

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