Both insurance companies and regulators are struggling to copewith the uncertainty that has ensued in the wake of the failure ofRepublicans to repeal and replace the Affordable Care Act with their own plan, theAmerican Health Care Act.

And it’s not just the legislative failure that threatens thesurvival of health insurance — the president’s threats, afterCongress couldn’t pull off its repeal-and-replace plans, to let theACA program “explode” are making insurers verywary of staying in the marketplaces set up by passage of the ACAunder President Obama.

Insurance Journal reports although insurers haven’t declaredtheir intentions yet, two strong possibilities could cripple theprogram are major increases in premiums and the departure from themarketplace by companies that aren’t satisfied with either theresults so far or the potential for improvement.

Although insurers view April 30 as the target for decidingwhether they’re in or out, based on President Trump’s threat tostop payments that subsidize copays and other upfront costs forlower-income people, they haven’t said definitely what their plansare. But in May, they’re expected to start filing with regulatorsconcerning their future in the program.

Without the subsidies, insurers would probably either increasepremiums or drop out entirely — but the administration, accordingto the report, “has refused to commit to keeping the paymentsgoing.”

Regulators fear a mass exodus by insurers from the markets — ormajor increases in premiums — will render the ACA coverageunattainable to many. And insurers aren’t talking — yet.

“Everybody is still in a wait-and-see mode,” Kristine Grow, aspokeswoman for the industry group America’s Health InsurancePlans, is quoted saying in the report. AHIP, along with otherindustry groups, is trying to win a commitment from theadministration to keep making the cost-sharing payments. Grow adds,“Plans really need certainty.”

But people seeking to buy insurance aren’t the only ones whowill suffer if the chaos spreads — hospitals could find themselveson the hook for care provided to those who can’t get insurance butstill must seek treatment.

The irony is that some insurers were looking at a rosierfinancial picture before all the chaos erupted around the battleover failure to pass the AHCA, which contained provisions at oncetoo harsh for Democrats and moderate Republicans while being fartoo lax to satisfy conservative Republicans.

Threats to cut the subsidies and political uncertainties aboutmajor changes to the law are threatening what otherwise would havebeen a profitable 2018, the report says, citing an S&P GlobalRatings analysis of Blue Cross and Blue Shield health plans. Theplans boosted rates more than 20 percent on average for this year,S&P said,

“The price increases they’ve put in as well as the networkdesign changes, that’s going in the positive direction,” DeepBanerjee, the S&P analyst who wrote the report, is quotedsaying. But he points out that the fate of the cost-sharingpayments is a major uncertainty. And if the Republican ACA repealbill changes things in 2018, “then all bets are off.”