The authors write that  ”newly established CO-OPs may be unable to maintain liquidity, disperse risk, lower premiums, exercise leverage, and establish branded statewide integrated care models. Moreover, CO-OPs ‘too small to thrive’ may default on their loans.”

“Viewed in this light, the road ahead is clear in calling for aggressive recruitment of enrollees through competitive pricing and product diversification.”

“At this time, the future of the existing CO-OP program remains promising if uncertain,” the authors say.