Policy makers and others often assume that a purchasing pool could achieve economies of scale and favorable health plan rates. While a well constructed pool has the potential to provide more affordable coverage for small firms and/or workers, creating a successful pool is a challenge.

The report outlines key factors that are important to a pool's success, such as factoring in the market environment.

It describes why key factors like membership cohesion need to be taken into account and how targeting low-wage subsidies through a pool can help the pool succeed and meet policy goals. It also observes that merely establishing a "pool" that does not have such characteristics is unlikely to reduce either costs or the number of uninsured.