What are the dynamics of pooled purchasing arrangements? In this study, the researchers: (1) identified and described different types of pooled purchasing arrangements, identified examples of each type, and discussed how such arrangements are regulated by states and the federal government; (2) described how coverage sold through such arrangements is regulated, focused on key market reforms and consumer protections as well as applicable federal standards; (3) provided estimates on the prevalence of such arrangements; (4) summarized how self-insured arrangements are regulated, identified weaknesses in the law, discussed recent insolvencies, and identified successful oversight approaches; and (5) discussed market failures focusing on the recent influx in health insurance scams promoted through pooled purchasing arrangements. The objective of this study was to inform state and federal policy discussions on expanding the role of association health plans and other pooled purchasing arrangements. In addition, it helped policymakers address current problems that consumers face such as insolvency and fraud.