Healthcare continues to be an important issue in United States policy discourse for both quality of life and financial reasons. According to a report published by the World Health Organization, the United States has the most expensive healthcare system in the world but continues to place low in both quality and mortality measurements. As a solution to the financial demands placed on healthcare , a draft of the Affordable Care Act called for the formation of not for profit health insurance agencies for each of the states. Not for profit health insurance companies demonstrate marked reduction of financial demands in Germany and other countries around the world. Deemed CO-OP's, some not for profit heatlhcare insurance companies were formed and currently operated in a select few states across the country with the assistance of federal funding. Conducting a systematic literature review, my research will examine whether not for profit health insurance companies are effective and feasible to operate independently long term in the United States.