On Tuesday, Aetna, the insurance giant, announced that it would decamp from Affordable Care Act health exchanges in 11 of 15 states in which it currently operates. Citing a $200 million pre-tax loss in the second quarter of 2016, the company says it will walk away from nearly 70 percent of its plans, a move that will leave at least one U.S. county in Arizona without an ACA provider. "As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision," said Aetna CEO Mark Bertolini in a statement.

The development is the latest evidence that, years after its implementation, the Affordable Care Act still represents an unhappy medium between those who want a more robust government-run healthcare system, those who want to cede healthcare to the private sector, and the insurance and medical industries. Texas Senator and failed Republican presidential candidate Ted Cruz, for example, tweeted out the news of Aetna’s decision with the hashtag #FULLREPEAL while Robert Reich, the former Labor Secretary under President Bill Clinton, characterized the development as “the best argument for a single-payer health plan.”

Though Aetna’s decision generally came as a surprise, there were indications that trouble was afoot when Aetna downgraded its expectations earlier this month, adding that it would not expand into five more state exchanges as previously planned. Aetna’s forthcoming withdrawal is the latest blow for the ACA, whose insurers argue that they have been overwhelmed by pools that don’t include enough healthy members to balance out heavier users. “Back when UnitedHealth was the only insurance company bailing out, it was easy to dismiss as just one company trying to boost its bottom line,” wrote Bloomberg’s Max Nisen earlier this month. “But when all five big insurers are bleeding money, it's clear you've got bigger problems.”