Summary: A common feature of many health reform bills is the creation of public or private health alliances that would seek to broaden coverage, pool risks, give consumers a choice of health care plans, and disseminate information on the costs and quality of plans. All the bills leave the establishment of alliance boundaries to the states. This testimony discusses (1) the provisions of major health reform bills concerning the configuration of alliance boundaries; (2) experiences of two states that have established entities similar to alliances; (3) features and procedures for creating a Metropolitan Statistical Area; and (4) issues relating to the potential effects of alliance boundaries on existing health markets, access to health care, and distribution of health care costs within a state. Concerns about the boundary provisions of the health reform proposals include the potential for gerrymandering, changing the provision and receipt of health care, segmenting high-risk groups, and isolating underserved areas.
