WASHINGTON — In Maine, the insurer that has enrolled the most Affordable Care Act customers isn’t the state’s well- established Blue Cross Blue Shield plan, owned by WellPoint Inc. It’s WellPoint’s only rival: Maine Community Health Options, a startup that didn’t exist three years ago.

The newcomer, funded primarily by taxpayer money lent under the U.S. health-care law, has won about 80 percent of the market so far in Maine’s new insurance exchange, exceeding its own expectations, said Kevin Lewis, the CEO.

Additional Photos

The Maine Community Health Options co-op occupies a refurbished mill in Lewiston. Funded primarily by taxpayer money lent under the U.S. health-care law, it has won about 80 percent of the market in Maine’s new insurance exchange. Telegram File Photo/Gordon Chibroski

Health law opponents predicted early on that insurance co-ops created by the law would fail, and that much of the $2.1 billion they were loaned to get started would be lost. Instead, the 23 co-ops that now exist nationally have enrolled about 300,000 people in health plans by combining low premiums with a certain homespun appeal, according to company executives.

“We’re doing really well,” Lewis said in a telephone interview. Taxpayers face “no risk whatsoever” that Maine Community will go under, he said. “A lot of those early, dire concerns just need to be re-examined.”

Kristin Binns, a spokeswoman for Indianapolis, Ind.-based WellPoint, declined to comment on her company’s co-op competition.

The 2010 Patient Protection and Affordable Care Act refers to these new companies as “Consumer Operated and Oriented Plans,” or co-ops. To be sure, not all of them have thrived. Some, such as Maryland’s, have struggled to sign people up because of problems with their state’s exchange while others, including Michigan’s, have set premiums too high.

The successful co-ops “emerged as price leaders,” responsible for more than a third of the lowest-premium plans offered on U.S. exchanges, according to an October report by McKinsey & Co. consultants.

Executives from these nonprofit groups in part credit innovative benefit designs, including features that offer free doctors’ visits and generic drugs, and even $100 gift cards for people who get an annual physical. In Wisconsin, many customers of Common Ground Healthcare Cooperative appreciate the company’s nonprofit, member-governed business model, CEO Bob DeVita said.

“There’s a long-standing upper Midwest tradition with co- ops,” DeVita said in a telephone interview. “I think there was a lot of pent-up demand for that.”

In Windsor Heights, Iowa, 35-year-old Geoffrey Wood, the chief operating officer of Startup Genome, said he signed on for the state’s co-op, CoOportunity Health, because he had grown tired of dealing with his previous insurer, Aetna Inc.’s subsidiary Coventry Health Care Inc.

“Given the choice between them, as the incumbent company, and an innovative company trying to do something different, I didn’t feel like I had much choice,” Wood said in a telephone interview. “I decided to give the new guy a shot.”

Cynthia Michener, an spokeswoman for Hartford, Conn.-based Aetna, said Coventry’s advantages for enrollees include experience with the Iowa health-care system and stability.

“Coventry Health Care has served Iowans for more than two decades, and knows the community and its health-care needs well,” Michener said in an email. “We have long-standing experience of providing health insurance and benefits and helping members access care, and a track record of financial stability to pay claims.”

About 4 million Americans have signed up for private health plans using new marketplaces created by the law, the U.S. government says. The Congressional Budget Office projects 6 million will enroll this year, a reduction of 1 million from estimates before the troubled introduction of the law began in October.

It hasn’t been a smooth road for some of the co-ops. The computer bugs and errors that prevented many Americans from signing up for coverage in October and November took a toll and, in some states, the startups continue to struggle.

Co-ops in Maryland, Oregon and Massachusetts, for instance, haven’t hit their target enrollments because their state-run exchanges still aren’t functioning well. And Vermont’s co-op dissolved in September, returning its federal solvency loans, after state regulators denied it an insurance license, saying the company’s enrollment expectations were unrealistic and its proposed rates weren’t competitive.

Along with Maine, co-ops have attained large market share in New York, Iowa, Nebraska, Colorado, Kentucky, Wisconsin, South Carolina, Utah, Montana, Nevada and New Mexico, said John Morrison, a board member and founding president of the co-op trade group, and other executives.

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