(Bloomberg) -- Many people shopping for health coverage on the websitescreated by the Patient Protection and Affordable CareAct are going to see double-digit percentage increasesin their premiums.

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That’s still not enough for some insurers.

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Anthem Inc. says there remain competitors in the government-runmarketplace offering premiums that aren’t enough to profitablyprovide the coverage patients will require.

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Read: 17.6 million have gained insurance throughPPACA

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Prices in some areas probably will have to climb in 2017 andeven 2018 to reach levels that make sense, according to ChiefFinancial Officer Wayne Deveydt. Meantime, Anthem will sacrificemarket share to keep its plans profitable, he said.

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“When you have fewer national enrollees and you have pricepoints that we don’t believe are sustainable, we’ve just made aconscious decision we’re not going to chase it,” Deveydt toldanalysts on a conference call last Wednesday. “We are going to needto be patient until this works itself out.”

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Deveydt’s remarks spotlight a problem for PPACA marketplaces asthe third annual sign-up period began Sunday.

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Set prices too low to lure customers, and losses can mount. Somesmaller firms already have closed, and some bigger insurershave withdrawn from markets--such as Aetna Inc., which will offercoverage in two fewer states this year.

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The conundrum has led to this year’s price increases, which havebeen higher, on average, than last year’s hikes.

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But the danger is that premiums are now too expensive for somefamilies to afford coverage, especially the uninsured people theObama administration is trying to persuade to shop on the exchangesfor the first time.

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“Exchanges have had their challenges,” said Ana Gupte, ananalyst at Leerink Partners who follows health-care companies. “Thegrowth has been reasonable, depending on where you priced, but themargins have been a little less compelling.”

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Insurers have benefited in many ways since the Affordable CareAct was signed into law in 2010. About 17.6 million people havegained insurance coverage, mainly through the health- insurancemarketplaces and an expansion of Medicaid, the U.S.’s program withstates to cover low-income people.

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The insurance companies administer coverage for much of thatpopulation, and their stocks have soared in the past few years onthe growth in their rolls.

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But the remaining uninsured are poorer and younger than thosewho’ve already signed up, and they’re more difficult to reach,Health and Human Services Secretary Sylvia Mathews Burwell hassaid. That may mean slower growth for the insurers.

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Faster than inflation

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Prices on the Affordable Care Act’s marketplaces are going upfaster than inflation or wages. By one measure, premiums formid-level plans are climbing at least 7.5 percent in 37 stateswhere consumers use the U.S.-run HealthCare.gov website to buycoverage.

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Charles Gaba, who tracks the health law on ACASignups.net,estimates that the rate increases across the U.S. will averageabout 12 percent to 13 percent, based on a weighted average ofcurrent enrollment. That means there are lots of consumers who areseeing higher rates and could benefit from re-examining theiroptions as the sign-up period starts.

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“Some of the large carriers are having pretty significant rateincreases,” said Jeff Smedsrud, who runs the private insuranceshopping site Healthcare.com. “Consumers should not automaticallyauto-renew. They should take the five to 10 minutes that it takesto compare” plans.

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PPACA subsidies

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Subsidies help lower the actual costs for many. Almost 80percent of individuals who’ve previously bought coverage on thePPACA website will be able to find a plan for less than $100 amonth after subsidies, the government has said.

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In fact, those who are eligible for the biggest subsidies aremore likely to enroll than people who have to foot more of the billthemselves, according to a report from the Robert Wood JohnsonFoundation and the Urban Institute.

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“There is no larger factor than affordability in terms ofdetermining whether people do or don’t get enrolled,” said RonPollack, the head of Families USA, a health-care advocacygroup.

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The health department has updated the HealthCare.gov website tohighlight how subsidies can reduce the cost of coverage. The sitealso can help individuals see how their choice of plans affectswhat they could end up spending out of pocket on health care.

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“We’re doing everything possible to make it easier for theconsumer,” Burwell said Thursday. “When we move on to an educatedconsumer, that’s when the marketplace works.”

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Dropping policies

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Price isn’t the only challenge for insurers, according to ShawnGuertin, Aetna’s CFO. Membership levels are lower than expected,and some individuals are sticking with pre-Obamacare plans, cuttinginto the size of the market. There’s also been lots of churn --customers signing up and then dropping their policies throughoutthe year.

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“We always knew this was going to be a multiyear proposition,for a new program of this size and scale,” Guertin said in aninterview.

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Aetna hasn’t been turning a profit in Obamacare plans, thecompany has said. Guertin said its price hikes range from highsingle digits to the mid-teens, depending on the market.UnitedHealth Group Inc., the largest U.S. health insurer, has saidits premium increases are in the double digits as well.

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Still, UnitedHealth is entering 11 new markets this year. Andoverall, about as many insurers are entering the exchanges are arequitting, according to data released Friday by the healthdepartment.

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Consumers buying coverage on HealthCare.gov have an average offive issuers to choose from for 2016 coverage, about the same aslast year, HHS said. Yet in six of the 38 states usingHealthCare.gov, consumers will have just one or two insurers topick from.

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The big publicly traded companies will pick up membership overthe next few years as they outlast small competitors like theconsumer operated and oriented plans known as co-ops, which haveset prices at unprofitable levels, according to Gupte, the Leerinkanalyst.

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Already, money-losing co-ops such as Health Republic Insuranceof New York and CoOportunity Health in Iowa have had to close.

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“The issues have been more around the very small plans, the newentrants, the co-ops,” she said. “As we see more of them exiting, Ithink the pricing environment will harden.”

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