Obamacare’s markets are becoming increasingly vulnerable as major health insurers exit, citing financial losses. Some insurers have stayed in, but raised the premiums they charge customers by double-digit percentages.

Problems new and old

Some of the instability has been going on for years, as fewer people than expected have signed up for plans and many have been sicker than insurers accounted for. Those problems have been further pushed by Republicans, who are considering legislation in Congress to repeal and replace large portions of the health law, and by President Donald Trump, who has threatened to withhold support from key portions of the law that keep the markets functioning.

Aetna’s decision could leave Nebraska with just one insurer, Medica. Medica has pulled back as well, saying it may exit the program in Iowa, leaving much of the state without insurance options under Obamacare.

Greg Bury, a Medica spokesman, said, “We have not made a decision and are reviewing all of our options.”

In Delaware, the Blue Cross and Blue Shield company Highmark would be the lone Obamacare insurer, assuming no other company enters. Highmark didn’t return a request for comment. The state’s insurance regulator blamed “the uncertainty and instability surrounding the future of the Affordable Care Act” for Aetna’s exit.

“I would hope that our elected officials in Washington will come up with solutions to guarantee that health insurance in Delaware and elsewhere is both available and affordable,” Insurance Commissioner Trinidad Navarro said in a statement.

Aetna may not be entirely out of Obamacare. Nevada has said it was working to convince the insurer to offer individual plans in the state for next year. T.J. Crawford, an Aetna spokesman, said the company had “no comment on a potential Nevada presence at this time.”

Copyright 2018 Bloomberg. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.