GAO reviewed the Department of Health and Human Services' (HHS) new rule on the Patient Protection and Affordable Care Act's Consumer Operated and Oriented Plan (CO-OP) program. GAO found that (1) the final rule implements the CO-OP program, which provides loans to foster the creation of consumer governed, private, nonprofit health insurance issuers to offer qualified health plans in the Affordable Insurance Exchanges (Exchanges). Starting in 2014, individuals and small businesses will be able to purchase private health insurance through state-based competitive marketplaces called Exchanges. Insurance companies will compete for new business on the basis of price and value and consumers will have a choice of health plans to fit their needs. The goal of this program is to create a new CO-OP in every state in order to expand the number of health plans available in the Exchanges with a focus on integrated care and greater plan accountability; and (2) HHS complied with applicable requirements in promulgating the rule.