The final regulations for the Consumer Operated and Oriented Plan (CO-OP) Program are similar to the draft version of the CO-OP regulations posted in July, according to Paul Keckley.
Keckley, executive director at the Deloitte Center for Health Care Solutions, Washington, says in a comment on the final CO-OP rule, which is set to appear in the Federal Register Tuesday, that one of the most notable features is the definitions regulators use.
The U.S. Department of Health and Human Services (HHS) is deveoping CO-OP program regulations in an effort create a new breed of nonprofit, member-owned health plans.
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Members of Congress put the CO-OP program provision in the Patient Protection and Affordable Care Act of 2010 (PPACA) to create a compromise between Democrats who wanted PPACA to create a government-run "public option" and Democrats who wanted PPACA to preserve the current commercial health insurance market as much as possible.
A CO-OP is supposed to make "substantially all" of its sales to individuals and small groups.
A CO-OP could operate in a whole state or in part of a state, or it could operate in multiple states. A CO-OP would be licensed as an insurer in each state in which it operates.
The CO-OP section of PPACA, PPACA Section 1322, calls for HHS to make $3.8 billion in CO-OP startup loans available to would-be CO-OP organizers.
When counting customers, "a CO-OP may treat coverage for a family of four as a 'small group,'" Keckley says.
The CO-OP could then count the family policies toward its small group quota and get a quarter of its business from big businesses or trade associations, Keckley says.
Keckley points out that HHS believes it may have enough PPACA CO-OP funding to make startup loans to about 57 CO-OPs.
John Morrison, chairman of the National Alliance of State Health Care Cooperatives, Helena, Mont., a group for CO-OP organizes, has put a statement welcoming the release of the final regulations.
"While NASHCO is still reviewing the rule's details, we are pleased with them in general," Morrison says. "They represent both opportunity and accountability for this important new industry."
Morrison says the CO-OP movement "is spreading like wildfire."
"Americans are desperate for a new approach to health coverage," Morrison says.
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Allison Bell
Allison Bell, a senior reporter at ThinkAdvisor and BenefitsPRO, previously was an associate editor at National Underwriter Life & Health. She has a bachelor's degree in economics from Washington University in St. Louis and a master's degree in journalism from the Medill School of Journalism at Northwestern University. She can be reached through X at @Think_Allison.
