"The average cost-per-enrollee for all 50 states plus DC was $922. For the 15 jurisdictions running their own Exchanges it was $1,503, while for 36 states in which the federal government operates the Exchange it was $647.... The state with the highest cost-per-enrollee of the 36 federally-operated Exchange states, based on allocating 1/36 of federal Exchange spending to each state, was North Dakota, at $7,089. The state with the lowest cost-per-enrollee was Florida, at $76.... [T]he more states in which the federal Exchange operates, the more money taxpayers save.... [S]tate officials refusing to establish their own Exchanges appear to have unwittingly contributed to the efficient implementation of the Exchange in their states."

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