The idea is still only in the infancy stage. It’s unclear whether a California-Oregon or New York-Connecticut health exchange is on the horizon.

But a shared marketplace — an option buried in a little-known clause of the Affordable Care Act — has become an increasingly attractive option for states desperate to slash costs. If state exchanges are not financially self-sufficient by 2016, they will be forced to join the federal system, HealthCare.gov.
“What is happening is states are figuring out the money is running out,” said Jim Wadleigh, the director of Connecticut’s exchange, hailed as one of the most successful in the country. “At the end of 2016, everyone has to be self-sustaining.”

Other states are being driven to consider the idea by the King v. Burwell case, in which the Supreme Court will decide whether subsidies are allowed in states that didn’t set up their own health exchanges.