Consumer Operated and Oriented Plans (CO-OPs)

This report provides a preliminary look at prospects for the ACA’s Consumer Operated and Oriented Plans (CO-OPs)—nonprofit, member-governed insurance plans. The Department of Health and Human Services recently proposed rules for this loan program and announced funding opportunities for CO-OPs.

The report, written by the Urban Institute’s Bradford Gray, finds that in addition to upfront financial and governance hurdles, CO-OPs will likely face challenges building robust provider networks and recruiting enrollees. A restriction in the ACA on the use of loan funds for marketing adds a complication. Member governance may also pose challenges.

The report suggests that the long-term success of CO-OPs will depend on their ability to move beyond the individual and small group markets, work collaboratively with each other and evolve beyond reliance on existing administrative organizations and provider networks.