The Financial Condition and Performance of CO-OP Plans

Participants at a conference table.

Researchers examined the nation’s Consumer Operated and Oriented Plan (CO-OP) Program to determine potential challenges to achieving long-term viability. This data brief examines the operating and financial performance of the nation’s 22 other CO-OPs in the liquidation wake of CoOpportunity Health, which operates in Iowa and Nebraska.

The Issue

Research looked at funding, enrollment, rates and underwriting results for the 23 insurers established thanks to the Affordable Care Act’s CO-OP Program. CO-OPs were intended to increase consumer choice and competition among health plans.

Key Findings

  • The plans took hold in nearly half of states.

  • Data from the third-quarter of 2014 indicate substantial variation in their performance to date—with considerable differences in terms of enrollment, pricing and underwriting results.

  • It’s been long recognized that CO-OPs would likely face formidable operational and financial challenges, and that some would not become financially viable.


The researchers stress CoOpportunity Health’s insolvency heightens concerns over these challenges and the need for monitoring and oversight of CO-OP pricing and enrollment growth going forward.

About the Grantee

The Leonard Davis Institute of Health Economics (LDI) is the University of Pennsylvania’s center for research, policy analysis, and education on the medical, economic, and social issues that influence how health care is organized, financed, managed, and delivered.

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