The Blue Cross rate increase was higher in 2016 because it was the first year the insurer had a full year of data to evaluate rates, Tajlili said.

Though the insurer says its ACA plan is to cover all 100 counties in 2017, it continues to warn it may consider dropping counties from eligibility, if not exit the N.C. market altogether. Blue Cross was the only insurer to provide statewide ACA coverage for 2014-16.

“The company will file a list of counties where it will sell ACA plans with the Centers of Medicare and Medicaid Services in late August,” the insurer said.

Tajlili echoed comments from Brad Wilson, its chief executive, that “all options are on the table ... because we can’t continue to sustain losses (on the ACA plans) of this magnitude.”

“We must be able to set prices to cover our costs in the marketplace.”

The insurer reported Feb. 26 it lost $600 million on ACA-related patient care when not including federal reimbursements, and $282 million when including them. In 2014, the insurer lost $452 million when not including federal reimbursements, and $123 million when including them.