Why Are Many CO-OPs Failing? How New Nonprofit Health Plans Have Responded to Market Competition

The Affordable Care Act (ACA) created the Consumer Operated and Oriented Plan (CO-OP) Program to provide consumer-focused health insurance options. But the CO-OP experience to date reveals factors that limit market competition. This report considers the challenges that CO-OPs have faced through analysis of plan, pricing, and enrollment data for six CO-OPs. It describes how CO-OPs responded to the prohibition on using federal loans for marketing, problems associated with outsourcing health plan functions, CO-OP plan design and pricing strategies, dynamics of both high and low enrollment, and challenges related to the ACA’s premium stabilization programs. It includes a discussion of the role of federal and state policy decisions in adding to rather than reducing barriers to market entry for CO-OPs.