The Affordable Care Act (ACA), also known as Obamacare, faces an uncertain future.

Despite the failure of the American Health Care Act, the Republican bill which would have repealed and replaced the ACA, President Donald Trump has made moves regarding the administration of the ACA that could undermine the law.

The ACA, however, also had issues before it fell into Trump's cross hairs. For one thing, the mix of people signing up for insurance on the ACA's individual insurance exchanges was leading to large losses for insurance companies, with more older and sicker patients and fewer younger and healthier enrollees than expected. These insurers, facing continued losses, began to pull their plans from the exchanges.

Data from the Department of Health and Human Services laid this dilemma out clearly by showing the number of insurance companies that yanked their plans from each states' exchange between the 2016 and 2017 plan years.

25 of the 38 states with exchanges run through the federal Healthcare.gov platform had a decrease in the number of insurers on their exchanges in 2017.

Large states like Ohio, Pennsylvania, Texas, and Arizona led the way in terms of insurer losses. Interestingly, Ohio, Arizona, and Pennsylvania were all swing states in the 2016 election that broke for Trump.

By contrast only two states — Maine and Iowa — saw an increase in the number of insurers.

While this isn't necessarily a death knell for these exchanges, it is a worrying trend that will only get exacerbated by the political uncertainty surrounding these marketplaces.