HispanicBusiness

"Everything we do will be consumer-focused and consumer-friendly. The nonprofit insurance model is a very different model for Nevada."

The CO-OP is looking for office space and staffing up now. It is hiring directors of operations, outreach and advocacy, and is looking for workers in member services and care management.

Bond said she expects the group to have about 40 employees by the end of 2013.

The Centers for Medicare and Medicaid Services will monitor CO- OPs through quarterly financial statements, cash flow numbers, enrollment data, site visits and annual external audits.

Hospitality Health CO-OP received two loans totaling $65.9 million from the Centers for Medicare and Medicaid Services in May, to ensure it has assets to pay its claims. The CO-OP will pay back the loans from its profits over five to 15 years.

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J-Robison1 on Twitter.

Health care reforms already in effect

Some reform provisions are already in full force and affecting consumers, insurers and health care markets:

* Children and pre-existing conditions. As of 2011, insurance companies could no longer cite pre-existing conditions to limit or deny benefits or coverage on insurance policies for those under 19. The Obama administration credited the rule with guaranteeing coverage to 17 million American children with pre-existing conditions. In practice, though, the law has had unintended consequences. A 2011 Politico study found that insurers in 34 states stopped selling child-only insurance policies, and 20 states - including Nevada - no longer have any carriers selling child-only policies. The reason? Insurers said parents would wait until their children got sick to buy coverage, and premiums for all policyholders would spike to cover the costs of a less-healthy membership pool.

* Insurance for dependents. After September 2010, kids could stay on their parents' insurance plans until age 26. Observers agreed the law had an effect: Numbers from the Centers for Disease Control and Prevention showed an 18 percent drop in 2011 in the share of young adults without health coverage. Health policy experts at both liberal and conservative think tanks credited the decline to this provision of Obamacare. But some policy watchers said the number of insured young fluctuates with the economy, which improved from 2010 to 2011 and may have given 20-somethings more access to jobs and employer-sponsored health care. Plus, some young adults who could have qualified to buy plans on their own through work likely opted to stay with mom and dad's plan to save on premium costs and boost take-home pay, so there are doubts about whether the regulation reached truly uninsurable kids. And a 2012 report from human resources consulting firm Towers Watson found that dependent- coverage rules boosted overall premiums 3 percent and have encouraged increasing numbers of employers to stop covering dependents altogether.

* No out-of-pocket costs. Obamacare prohibited providers and insurers from charging patients for routine physicals, vaccines, mammograms and other preventive care and screening after 2010. But the rule applies only to insurance policies written since it took effect. Little research is available on how this provision has