This has been coming for some time and today Aetna made it official. The company will not participate in any Obamacare exchanges in 2018. From Fox Business:

“We will not offer on- or off-exchange individual plans in Delaware or Nebraska for 2018, and at this time have completely exited the exchanges,” Aetna said in a statement to FOX Business… “Our individual Commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership.”

The decision will leave the state of Nebraska with just one remaining insurer. The Lincoln Journal Star reports Medica has committed to offering plans in the state next year but has not submitted any proposed rates yet. Similarly, in Delaware, Highmark Blue Cross Blue Shield will be the last remaining insurer in the state.

Aetna announced it would exit the Virginia market last week. And last month it said it would be leaving the Iowa exchange. That decision was big news because it meant there was only one insurer offering coverage in most of the state. Medica, which just became the last insurer in Nebraska, said last week it was considering following Aetna’s lead out of Iowa. A final decision hasn’t been announced, but if it happens that would leave all but a small handful of counties in Iowa with no coverage options at all.

While the situation in Iowa is still up in the air, things improved slightly in the state of Tenessee yesterday. After Humana announced it would leave the market, one region of the state including the city of Knoxville was looking like it might have no insurer at all next year. But yesterday Blue Cross Blue Shield of Tennessee agreed to step in. That should prevent people from having no options though the company’s CEO did warn that if something substantial changed (repeal of Obamacare, cutting off of cost-sharing payments, etc.) the company would reserve the right to reconsider.

Obamacare is struggling even without the uncertainty introduced by the Trump administration. And if insurers continue to request double-digit rate hikes again this year, that will further discourage anyone who isn’t getting subsidies from buying in.