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Iowa's CO-OP pulls out of marketplace despite first-year success


The Affordable Care Act's consumer operated and oriented plans (CO-OPs) have had their fair share of ups and downs.

For example, Maine Community Health Options enrolled 83 percent of the 44,000 Mainers who purchased health insurance on the marketplace last year, despite competing against big insurers like Aetna and Blue Cross Blue Shield, FierceHealthPayer previously reported.

Similarily, Iowa's CoOportunity Health enrolled more than 35,000 members by Jan. 1, surpassing its first-year target of 12,000 members, and earned $127 million dollars in premium volume. Yet despite enrollment success, the state's CO-OP will no longer offer plans on Iowa's Marketplace Choice Plan, Employee Benefits News reports.

CoOportunity Health and Aetna-owned Coventry Health Care were the only two carriers offering coverage to individuals who qualify for the state's version of Medicaid. Coventry had the opportunity to absorb CoOportunity's business but neglected to do so, citing reasons of high loss ratio and poor risk profile of the given population, CoOportunity Health CEO and president Cliff Gold stated in the article.

If the company had stayed in the state's Medicaid program, the funds--which came from federal government loans and premiums paid by members--would have disappeared quickly, notes EBN.

The decision should not negatively impact the state's residents. "The program already has mechanisms in place that allow for Iowans to continue to be served under Iowa's Medicaid expansion waiver program," Angel Robinson, a consumer advocate with the Iowa Insurance Division, told EBN.

CoOportunity's decision, which impacts only those in Iowa, could nonetheless have nationwide implications. The fate of CO-OPs may indicate ACA success, as it remains to be seen how offering low-priced plans will affect the long-term financial health of CO-OPs.

For more:
- here's the EBN article

Related Articles:
CO-OPs attain lopsided success
Start up, CO-OP insurers are expanding into new markets
5 secrets to exchange enrollment success: CoOportunity Health