The Affordable Care Act (ACA) provides $6 billion in loans and grants to develop non-profit organisations that are run by their customers and meant to offer consumer-friendly, affordable health insurance options to individuals and small businesses. Plans, sold inside and outside the health insurance exchanges, will have to meet ACA standards for health plans.

CO-OPs are neither government agencies nor commercial insurers, and as such, were designed to put patients first, without worrying about investors or Congressional politics. The idea behind a CO-OP is that customers' health insurance needs and concerns become a top priority because the CO-OP's customer/members elect their own board of directors. What's more, a majority of these directors must themselves be the CO-OP's customers.

Profits made by the organisation must be used to lower premiums, improve benefits, or sustain programmes intended to enhance the quality of health care delivered to the CO-OP's members.