GRAHAM-CASSIDY REPEAL BILL DEADLINE:

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Believe it or not, a few Co-Ops are still hanging in there...and one is thriving.

Once upon a time there were 23 health insurance cooperatives created via ACA provisions, spread across a similar number of states (a few operated in more than one, while some states had more than one co-op operating within it).

The first one to fall was CoOportunity, which operated in Iowa and Nebraska. Their enrollments were halted in the middle of the 2nd Open Enrollment period, and they were liquidated before OE2 even finished.

Over the course of September and October 2015, over a dozen more co-ops went down in flames, falling like dominoes, with two or even three a week being shuttered. The timing was no conicidence--the contract signing deadline for the third Open Enrollment period was rapidly approaching, and state regulators had to take emergency measures in cases where they didn't feel a carrier had enough cash flow or liquid assets to be able to handle enrollee claims during the upcoming year. One by one, regulators pulled the plug; the co-op program had been poorly designed to begin with (watered down and weakened in countless ways in a futile attempt to win over conservative support), but the final, crushing blow was from what became known as the Risk Corridor Massacre.

7-8 of the Co-Ops managed to tough it out and survive Year Three, but the damage to some was too much: In the summer of 2016, several more went belly-up, including co-ops in Ohio, Illinois and Connecticut. One of them, in Maryland, made a last-ditch attempt at survival by converting itself into a private entity...but it wasn't meant to be.

As of today, there are just 4 of the original 23 Co-Ops still surviving, located in Montana, Wisconsin, Maine and New Mexico.

There's a silver lining here, however. I'm not sure how the other three are faring, but at least one of the four, the Montana Health Co-Op (which also operates in Idaho) seems to be not only surviving, but actually doing pretty darned well:

Montana's health care co-op, one of America's few remaining alternatives to traditional health insurance, will resume accepting new enrollees Sunday after it voluntarily pulled itself from the state's insurance marketplace in December.

The insurer took the nine-month hiatus from enrolling new members in the exchange created by President Barack Obama's Affordable Care Act to boost its financial reserves and keep it from the same fate that has befallen failed co-ops across the country.

..."When all the other co-ops were going down, we were losing money, too," said Jerry Dworak, the Montana Health Co-op's CEO. "Thankfully, we've turned things around."

This year, the co-op is projecting $28 million in profits, after weathering a string of losses. It lost about $6 million in its first year and more than $40 million the following year, Dworak said.

So confident is the co-op about its financial health that Dworak said it has the capacity to absorb all 64,000 Montanans who buy their insurance through the state's exchange. It now enrolls about 20,000 people who purchase individual plans on the exchange. Blue Cross and PacificSource, the other two providers on the exchange, have nearly 32,000 and 12,000 enrollees respectively.

State Auditor Matt Rosendale, whose office oversees Montana's health insurance market, said he has no immediate concern over Montana's co-op.

"Right now they are very strong, and I feel very comfortable," Rosendale said.

I should note that Matt Rosendale is a Republican who plans on running against incumbent Democrat Jon Tester, so this is a pretty impressive statement coming from him.

Admittedly, several of the co-ops which failed also had plenty of happy talk shortly before the rug was yanked out from under them, and given what a mess the 5th Open Enrollment Period is expected to be in general, there's no guarantee that the Montana Co-Op folks will still be giving a big thumbs up six months from now...but for the moment, at least, it's nice to see that they're still hanging in there.