(Photo: Douglas Healey/AP)

(Bloomberg) — Aetna Inc. will leave the few remaining states where it had been selling Affordable Care Act public exchange plans next year, making it the latest health insurer to pull out of the exchange system as Republicans attack the program as failing and work to dismantle it.

While the move is likely to attract outsize political attention, the decision affects just Delaware and Nebraska. The Hartford, Connecticut-based insurer already said last year it would pull out of 11 states, and in the last month announced plans to exit Iowa and Virginia.

(Related: Aetna to Quit Virginia’s ACA Exchange as CEO Limits Risk)

“At this time have completely exited the exchanges,” Aetna said in a statement Wednesday. The insurer will also stop selling off-exchange individual plans in Delaware and Nebraska.

Aetna had indicated it might pull out earlier this month, when Chief Financial Officer Shawn Guertin said the company would take steps to limit its financial losses in the program. Aetna has said it expects to lose more than $200 million on individual health plans this year in the four states where it’s still selling exchange plans.

Many major health insurers have been exiting the exchange system, 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 change large portions of the ACA, and by President Donald Trump, who has threatened to withhold support from key ACA programs that keep the exchange system 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 individual major medical insurance options.

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 the individual market. 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.”

— Read Humana Wants to Talk to Medicare Plan Brokers on ThinkAdvisor

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