Aetna is leaving the Affordable Care Act market nationwide, after the insurer announced Wednesday it would no longer be offering exchange products in Nebraska and Delaware in 2018.
What insurers will remain in the ACA market next year is becoming known as they face state deadlines to file their premium rate requests. The federal deadline is June 21.
Last month, Aetna said it would be leaving the ACA market in Iowa and it had previously said it would no longer be in Virginia. That left only Delaware and Nebraska.
Aetna expected to lose more than $200 million in individual business, on top of close to $700 million in losses over the past two years, according to CNN.
In 2017, Aetna withdrew from 11 of the 15 exchange markets in which it was participating.
Wellmark Blue Cross Blue Shield also said in April it would be pulling plans out of Iowa.
Other major insurers, including Humana have also announced they are leaving all or part of the exchange market for 2018 due to financial losses and the instability and uncertainty of the ACA.
President Trump and Republicans have said they are working to replace the ACA because it is failing, in large part due to the lack of choice for consumers because of insurers leaving the market.
Insurers have said they need financial stability, particularly in guarantees that the federal government would continue the cost-sharing reduction payments that allow them to offer lower deductible plans to low-income consumers. The president, who has control over whether the CSRs are funded, has said the payments would continue for now, but has given no assurances for the future.
The ACA had three other programs to help payers take on the mandate of insuring patients with chronic conditions and pre-existing conditions: risk adjustment, reinsurance and risk corridors.
Risk corridors payments became budget neutral after GOP leaders fought the payments, saying Congress never appropriated the funds. The payments remain in litigation. Recently, the Department of Justice appealed a $200 million judgement awarded to Moda Healthcare in its lawsuit against the government, according to the Portland Business Journal.
The American Health Care Act approved by the House and now in the Senate, includes no funding for insurers to cover high-risk consumers. Federally-funded high risk pools have been put forward in the bill for states that get waivers from offering essential benefits and covering those with pre-existing conditions.
The Congressional Budget Office is scheduled to weigh in on the cost of the AHCA plan and its effects, on Monday, May 22.