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

And it’s not just the legislative failure that threatens the survival of health insurance — the president’s threats, after Congress couldn’t pull off its repeal-and-replace plans, to let the ACA program “explode” are making insurers very wary of staying in the marketplaces set up by passage of the ACA under President Obama.

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