A CO-OP plan could operate in a whole state or in part of a state, or in multiple states. A CO-OP would be licensed as an insurer in each state in which it operates.

Although a CO-OP plan would offer coverage through the exchange system, it also could sell coverage outside of an exchange, according to officials at the Center for Consumer Information and Insurance Oversight (CCIIO), the arm of the U.S. Department of Health and Human Services responsible for bringing the CO-OP program to life.

Congress has allocated a total of $3.4 billion in CO-OP loan funding, and CCIIO officials are hoping entities to start CO-OP programs that will serve each state and the District of Columbia.

The CCIIO recently announced it was making about $639 million in loans to seven would-be CO-OP organizers.

Affiliates of Freelancers Union, New York, received three of the loans. A group led by John Morrison, the former Montana insurance commissioner, received a CO-OP loan for Montana. Monica Lindeen, the current Montana commissioner, was one of the speakers.

Morrison is the president of the National Alliance of State Health Cooperatives (NASHCO), Helena, Mont., the CO-OP organizer trade group that set up the CO-OP organizer meeting.

The CO-OP organizer meeting, which took place last week in Washington, attracted about 150 participants, NASHCO says.

NASHCO says the event attracted 27 CO-OP development groups from 32 states.

NAHU sent Brooke Bell, a member of its government relations staff, and several members to the meeting.

States can choose between running their own insurance exchanges and letting the federal government provide exchange services for their residents.

Lindeen, a Democrat, and another Democratic speaker at the NASHCO meeting, Mississippi Gov. Ronnie Musgrove, said CO-OP attendees should work with state lawmakers on creating exchanges, because state-based exchanges likely would be more flexible and friendlier to CO-OP plans, NAHU says.