The PPACA healthcare reform allowed for the creation of non-profit state co-ops. Of the 23 state co-ops initially founded after the PPACA was signed, only 7 remain. The rest have gone out of business and left a hefty tab for taxpayers to absorb. "Taxpayers are out $1.7 billion in federal loans that these co-ops will never pay back."
The 4 remaining nationwide medical insurance carriers (Anthem Blue Cross, Aetna, CIGNA, and United Healthcare) are often villainized as the big money profiteers of the US health care system. Their financial strength and operational know-how are effective at engaging market forces to keep our system afloat and competitively priced.