(AP Photo/Jon Elswick, File)

(Bloomberg) — Obamacare’s startup health insurance plans are flirting with financial distress, as all but five of the 23 nonprofit companies had negative cash flow from operations in the first three quarters of 2014, Standard & Poor’s said in a report today.

The startups, called Consumer Operated and Oriented Plans, or co-ops, were created with $3.4 billion in federal loans as a counterweight to established health insurers. One of the largest of the companies, Iowa-based CoOportunity, has failed already and is being liquidated by the state.

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