The first loans for creation of Consumer Operated and Oriented Plans (CO-OPs) are expected in early 2012. Proposed as an alternative to the public option in the health reform debate, CO-OPs are to be nonprofit, member-governed health plans that create innovative care delivery models to serve the individual and small group markets in various states. The Patient Protection and Affordable Care Act has features that are attracting potential developers of CO-OPs, but it also contains provisions that will make success more difficult. This status report, funded by the Robert Wood Johnson Foundation, covers the provisions of the legislation that will affect who seeks CO-OP funding and whether they are likely to survive and grow. CO-OPs may become important insurance options in some markets, but it is difficult to foresee their having a transformative effect that was expected of the public option.