Aetna, one of the largest health care insurers in the United States, is facing profitability headwinds from participating in the Affordable Care Act exchanges and has hinted that it may exit more in 2018.

In August of last year, Aetna announced it would limit its participation in the Obamacare exchanges in 2017, scaling back offering coverage from 778 to 242 counties after the company cited losses of more than $430 million since January 2014. The insurer said it would continue participating in four states, Delaware, Iowa, Nebraska, and Virginia.

Aetna released its first-quarter results from 2017 and reported a net loss of $381 million and adjusted earnings of $939 million. The insurer noted profitability issues associated with the Affordable Care Act, even going so far as to set aside a fund to buffer the company from projected losses.

"This strong start to the year has enabled Aetna to absorb continued pressure from our individual commercial products while increasing investment in our growth initiatives and raising our full-year 2017 earnings per share projections," said Mark Bertolini, chairman and CEO of Aetna.

"During first-quarter 2017, Aetna recorded a $110 million premium deficiency reserve that reflects anticipated future losses for the 2017 coverage year in Aetna's individual commercial products," the company said.

On an earnings call, Shawn Guertin, Aetna's chief financial officer, noted that Obamacare profitability continued to face headwinds and that the company would attempt to reduce its exposure to this segment of business.

"With respect to our Individual Commercial products, we continue to face headwinds related to profitability," Guertin said. "From a membership perspective, we ended the quarter with 255,000 individual commercial members, down from 964,000 at year-end 2016."

"Looking beyond 2017, we continue to evaluate our footprint with a view towards significantly reducing our exposure to individual commercial products in 2018," he said. "We have already disclosed our planned 2018 exit from one of our 2017 state-based exchanges and intend to communicate other 2018 footprint decisions when appropriate."

Earlier this year, Aetna's CEO said Obamacare was in a "death spiral," citing higher premiums and an increasing number of healthier individuals dropping out.

Bertolini also called for a health care product that is more suited to individual needs and budgets. "Eighty-one percent of the American public hate their health insurance, they hate the health care system. We have too many uninsured, it's not affordable even for people making six figures."

"So it still has to be fixed, we still need to insure everybody," he said. "We still need to have a product that's affordable, more personalized, simpler to use, that people can buy like they buy everything else today."