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CO-OPs

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.

(Note: I've had to re-work some of this entry thanks to clarifications from Adam Cancryn about the RBC rule; too many little edits to document each one).

Last week I posted about the latest ugly Co-Op meltdown, this time Land of Lincoln Health (LoL) of Illinois.

As pointed out in my follow-up entry, given the precarious financial state LoL was already in last year, it made little sense that they only asked for fairly nominal rate hikes:

Now, since LoL went belly-up mid-year regardless, obviously even those massive rate hikes weren't enough to save them, so the question is, what would have happened if LoL had gotten their nominal increases as requested?

(sigh) Once upon a time, there were 24 ACA-created Co-Ops. Then, after one of them failed to even make it through the 2nd open enrollment period, a variety of factors (culminating in the infamous Risk Corridor Massacre) caused another dozen or so to curl up & die, falling like dominoes throughout last September/October.

When the dust settled, there were 11 Co-Ops left standing, but most of them were still on pretty shaky ground, with all but a handful placed under "enhanced oversight" by their states (and I have to admit that the term sounds an awful lot like a euphamism, a la "enhanced interrogation technique").

Throughout last September and October, I chronicled the dominos-like downfall of a dozen ACA-created Co-Op insurance carriers. They tumbled, one by one, as a result of a perfect storm of problems, some of which dated back to the final version of the ACA which was signed into law; others which cropped up along the way:

Conrad's plan called for $10 billion of government grants distributed among nonprofit, member-owned health insurance startups. The money came with few restrictions. Competing against big for-profit insurers is difficult, Conrad said. The co-ops needed as much freedom as possible to ensure their survival.

Ever since I laid into Congressional Republicans on Friday for deliberately sabotaging the funding program for the ACA's CO-OP Risk Corridor program last December, several people have correctly pointed out that, while having federal funds cut for this program cut off was certainly a major factor in at least one of the CO-OPs going under (the Kentucky Health CO-OP), there was a different policy change--made nearly 2 years ago--which may also contributed to their financial woes (and which may have played a role in some of the other 4 CO-OPs which fell apart prior to the risk corridor debacle hitting home a week or so ago).

The Office of the Inspector General released a big report today which confirms what most healthcare/ACA observers have known for awhile now: The CO-OP organizations established by the ACA across 2 dozen states to help increase competition and keep the private, for-profit insurance companies (somewhat) honest...haven't been doing very well overall.

One of these (CoOportunity, which operated in Iowa and Nebraska) seemed to be kicking ass in 2014...but ended up being liquidated by the end of the year. A second, operating in Louisiana, just announced that they're shutting down operations by the end of this year. As the OIG report notes, most of the 21 other CO-OPs nationally aren't doing so hot...and they used an absurdly long title (with an absurdly New York Post-style font size) to say so: