PPACA CO-OPs: Advocacy Group Raises Questions

Program rules forbid for-profit health insurers from creating CO-OP plans or participating in CO-OP plan governance.

The federal Center for Consumer Information and Insurance Oversight (CCIIO), the CMS arm overseeing the program, are hoping entities to start CO-OP programs that will serve each state and the District of Columbia.

The CO-OP program has attracted the involvement of Freelancers Union, New York, and other groups often viewed as being consumer advocacy organizations.

Health Access California

In California, Health Access California, Sacramento, Calif., has been the most visible source of concern about A.B. 1846.

Health Access has backed employer health coverage mandates, proposals for establishing a government-run health plan option, and other coverage expansion proposals.

CO-OP concept supporters may not fully understand how the plans might work if the wrong kinds of laws are adopted, the group says.

One major challenge is that PPACA could free CO-OP plans from some of the quality and bargaining processes that would apply to other insurers participating in the PPACA exchange program, the group says, according to a summary providing by the Assembly legislative analysts.

Health Access has argued that a CO-OP is not an alternative to a "public option," or government-run health plan.

California lawmakers should make sure that CO-OPs have to meet the same exchange requirements that other carriers participating in the PPACA exchange program face, the group says.

Lawmakers also should " require that the members of the CO-OP be the individual consumers rather than employers," according to the analysts' summary of the group's comments. " Require a vote of the members to elect the CO-OP board. Prohibit any individual with financial interest in or income from an insurer, health plan or multiple employer welfare arrangement."