“CO-OP enrollment for the first-quarter of 2015 was 869,677 compared to 478,152 for the fourth-quarter of 2014,” said Kaminski. “This increase in enrollment on future financial performance is significant, because it demonstrates that interest is growing, along with a better understanding of how these CO-Ops operate. Additionally, for the smaller plans, the increase has allowed them to build up some scale, which is crucial for their viability going forward. However, the CO-Ops are challenged with operating efficiencies that are below par, having combined ratios as a group of over 110%. ”