Health insurers began to bring the real look of the 2017 HealthCare.gov exchange plan menus into sharper focus Friday.

That was the day when issuers were supposed to make final decisions about what they will (or won’t) sell through the U.S. Department of Health and Human Services’ exchange enrollment and policy administration system during the upcoming open enrollment period.

Related: Florida Blue to have many ACA exchange shelves to itself

The next open enrollment period is supposed to start Nov. 1 — a week before Election Day — and end Jan. 31, when the country has a new president. 

Early on, before carriers had submitted any rate filings for 2017, Andy Slavitt, the acting director of the Centers for Medicare & Medicaid Services, told Congress he believed HealthCare.gov, or “the Marketplace,” would be able to fill its shelves for the fourth open enrollment period.

Related: Andy Slavitt expects health insurers to ‘fill shelves’ in 2017 [With video]

Since then, Hartford-based Aetna, Louisville, Kentucky-based Humana and Minnetonka, Minnesota-based UnitedHealth Group have all announced major cutbacks in their 2017 exchange plan offerings.

Executives at Indianapolis-based Anthem, a publicly traded company that controls many Blue Cross and Blue Shield plans, expressed impatience, but that company has maintained at least some presence on the exchange system in all states it serves.

Agents and brokers have been watching to see what the other Blue Cross and Blue Shield carriers will do. In most states, they are the dominant carriers, based on the advantages they built up when the U.S. health insurance market was in its infancy.

For a look at what the Blues announced last week in three major markets, read on:

Consumers in Omaha, Nebraska, will start 2017 with just two individual exchange coverage options. (Photo: Thinkstock)

Consumers in Omaha, Nebraska, will start 2017 with just two individual exchange coverage options. (Photo: Thinkstock)

1. Nebraska

Omaha, Nebraska-based Blue Cross and Blue Shield of Nebraska said it will pull out of the HealthCare.gov shelves throughout the state, but continue to sell individual coverage through agents, and through its own website.

The company says it made the decision because it has lost about $140 million on selling Affordable Care Act public exchange plans since the exchange system came to life, in 2014, and sees no signs the system has matured.

“Serious issues with the health care have made the public Marketplace unstable, which is driving increased costs and decreased competition and consumer choice,” the company said in a statement. “We will evaluate the feasibility of a possible return to the public Marketplace in 2018 based on its improved stability.”

Related: 3 spasms of 2017 health rate filing pain

Pittsburgh's Blue Shield carrier is suing the United States over ACA risk corridors program administration. (Photo: Thinkstock)

Pittsburgh’s Blue Shield carrier is suing the federal government over Affordable Care Act risk corridors program administration. (Photo: Thinkstock) 

2. Pittsburgh

Pittsburgh-based Highmark splits the Pennsylvania commercial health insurance market with other companies that hold the rights to use the Blue Cross logo, the Blue Shield logo, or both logos.

Highmark has sued the federal government to object to the government’s failure to make the full payments associated with the Affordable Care Act risk corridors program, a program that was supposed to encourage ACA exchange plan issuers to hold rates low in 2014, 2015 and 2016 by using cash from thriving issuers to help struggling issuers. The program collected only enough cash to pay about 13 percent of 2014 claims.

Federal officials have said they will use any program cash they collect for 2015 to try to pay more of the 2014 obligations.

Related: Why Highmark’s $223 million PPACA suit matters to agents

The company said it lost $68 million on ACA programs in the first half of the year.

In spite of the problems, the company said Friday it will stick with the exchange system in 2017 and work to stabilize its exchange plan operation.

Tennessee's dominant carrier is using a market-by-market strategy. (Photo: Thinkstock)

Tennessee’s dominant carrier is using a market-by-market strategy. (Photo: Thinkstock)

3. Tennessee

Chattanooga, Tennessee-based Blue Cross Blue Shield of Tennessee said it has decided to sell HealthCare.gov plans in some parts of the state in 2017 and pull out in other parts.

The company will sell individual exchange plans in five rural areas of the state, but not in the Knoxville, Memphis or Nashville areas.

Hartford-based Aetna will sell individual plans outside of the exchange system throughout the state. Bloomfield, Connecticut-based Cigna and Louisville, Kentucky-based Humana have submitted filings that could give them the ability to sell individual exchange plans in the state’s urban exchange markets. 

Related:

UnitedHealth to exit Michigan PPACA exchange, state says

CMS hates some agents and other draft 2017 PPACA parameters

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