> The trouble with Amazon trying to become THE payer or TPA is that insurance is highly variable across the country. There are many different laws governing ins

> The trouble with Amazon trying to become THE payer or TPA is that insurance is highly variable across the country. There are many different laws governing insurance in each state, and you need to strike business agreements with literally countless small practices, hospital systems, lab service providers, drug companies, outpatient clinics, etc. It would actually be a massive administrative feat for Amazon to provide solid coverage across the US. It's possible to start small, no? One metropolitan area at a time, make deals with local orgs, slowly transition local employees over to the new plan. The 75 employees working at the Iowa datacenter may stay on their current insurance for a while, but I don't think that's a terribly difficult obstacle for the idea.