Only seven are left out of the original 23 — and those seven are struggling to find a way to survive.

A Kaiser Health News report said that those seven health co-ops — referred to in the Affordable Care Act as consumer operated and oriented plans — are, despite their survivor status, having a tough time staying in business. Eleven are still operating, but four of them will shutter by the fall thanks to insolvency. And the period of their demise is short: all 23 were operating in 2014.

Problems dogging the co-ops include a lack of diversification in their client base; the need to pay out funds to other insurers that are classified as bearing higher risk; and a lack of promised federal funds, which hit small insurers hard.

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