By Jay Hancock

They have rented offices and zero customers. All their capital is borrowed. They’re trying to sign the kind of expensive, chronically ill individuals that insurers have avoided for decades. In three weeks they face mighty competitors with a hundred times the resources.

But the 24 insurance-company startups created by the Affordable Care Act say they’re ready to battle the establishment, stay in business and change health care.

“What we’re doing is a big part of the ACA story,” said John Morrison, president of the National Alliance of State Health CO-OPs. “We bring a completely different paradigm to health care finance. We’re not interested in making as much money as we can. We’re not interested in making profits. What we are interested in is making consumer patients healthy and saving money.”

Morrison and other co-op officials talked to reporters Wednesday while in Washington for a NASHCO meeting.

The health law designed co-ops to give competition to Blue Cross, Aetna, UnitedHealthcare and other commercial insurers. Private, nonprofit co-ops emerged as a compromise after Congress balked at establishing a government-run “public option” insurer.

Individuals and small employers will be able to buy co-op policies through the ACA’s online marketplaces — along with plans offered by other carriers — in the two dozen states where they do business. The marketplaces are scheduled to open Oct. 1. The original idea was to have a co-op in every state, but Congress cut startup funding.

“I’ve been on the job less than 365 days. We stood up an insurance company in less than 365 days,” said Janie Miller, CEO of Kentucky Health Cooperative. “We’re sort of in the eye of the hurricane right now. But it’s an exciting hurricane.”

Part of the excitement comes from trying to enroll members when co-ops aren’t allowed to use their federal startup loans for advertising. They’re trying to get the word out through community groups, clinics and hospitals.

“I feel pretty confident that we’re going to have tens of thousands of Iowans and Nebraskans going on the marketplace, and they’re going to see us,” said David Lyons, CEO of CoOpportunity Health, which will sell plans in both those states. “And they’re going to like what they see.”