Blue Cross and Blue Shield of Nebraska and UnitedHealthcare left the exchange in 2016.
Remaining insurers are requesting big rate hikes for next year. Policyholders are continuing to rack up bigger bills than their premiums cover, and insurers remain concerned about the uncertainty emanating from Washington D.C. Carriers are particularly anxious about whether they'll continue to receive the cost-sharing subsidies that reduce premiums for lower-income consumers and whether the Trump administration will keep enforcing the individual mandate, which helps entice healthier people into the market.
Obamacares markets are becoming increasingly vulnerable as major health insurers exit, citing financial losses.
With the latest departures, more than 40 percent of US counties would have only one insurer selling coverage on their marketplaces for next year, according to data compiled by The Associated Press and the consulting firm Avalere.
When insurers leave, prices rise.
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In a statement, Aetna said the combination of high numbers of new members and a larger share of members needing high-cost care "coupled with the current inadequate risk adjustment mechanism, results in substantial upward pressure on premiums and creates significant sustainability concerns".
Aetna has said it expects to lose more than $200 million on individual health plans this year in the four states where it's still selling Affordable Care Act plans. In 2016 the insurer sold plans across fifteen states.
Aetna's CEO Mark Bertolini said that if Obamacare does not get fixed and nothing happens to it, "it is going to continue to deteriorate". Similarly, in Delaware, Highmark Blue Cross Blue Shield will be the last remaining insurer in the state. Such policies do allow people to meet the ACA's individual mandate for health insurance, but they are not eligible for tax credits. The insurer once covered more than 800,000 people through that marketplace, but it says steep losses have forced it to rapidly scale back.
Customers are likely still several months away from knowing for certain final 2018 rates and participation. Medica has pulled back as well, saying it may exit the program in Iowa, leaving much of the state without insurance options under Obamacare.