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Aetna will complete its withdrawal from Affordable Care Act insurance exchanges for 2018, announcing on Wednesday that lingering financial losses and uncertainty about the marketplaces’ future was prompting it to exit two final states. According to an Aetna spokesman, the insurer will not sell individual health plans next year in Delaware or Nebraska. Its announcement came a week after the company said it would stop offering ACA health plans in Virginia in 2018 and a month after it said it would leave Iowa. (Goldstein, 5/10)

Aetna said its individual plans are projected to lose more than $200 million this year, and “those losses are the result of marketplace structural issues that have led to co-op failures and carrier exits, and subsequent risk pool deterioration.” The insurer said that “at this time [we] have completely exited the exchanges.” (Wilde Mathews, 5/10)

"This decision is not a surprise given continued uncertainty about market stability and whether cost-sharing subsidies will continue to flow," Evercore ISI analyst Michael Newshel said in an investor research note. He noted that only one health plan remains in both Delaware, where Highmark Blue Cross Blue Shield sells Obamacare coverage, and Nebraska, where Medica still offers coverage but has warned it may exit the program. (Beasley, 5/10)

The political significance is greater than the impact on consumers. Aetna had already scaled back its presence and did not rule out entering another state market in 2018. But it is the second major national insurance company, after Humana, to abandon the pool of customers who buy their insurance coverage from those companies on HealthCare.gov and state-based exchanges for 2018. (Mershon, 5/10)

Aetna’s decision could leave Nebraska with just one insurer, Medica. Medica has pulled back as well, saying it may exit the program in Iowa, leaving much of the state without insurance options under Obamacare. (Tracer, 5/10)

Aetna sold plans on the exchanges in just four states in 2017, down from 11 in 2016. (Livingston, 5/10)

A report from S&P last month found that the financial situation was stabilizing for insurers on the marketplaces, absent drastic changes to the law from Washington. (Sullivan, 5/10)

Health insurers are asking state regulators to approve giant rate increases for 2018 individual policies, in part because they don't yet know if the Trump administration plans to help or hurt the Affordable Care Act's health insurance exchanges. Insurers in the three states that have published requested rates say their double-digit hikes, which exceed 50% in some cases, may climb even higher if the federal government doesn't take steps to ease their jitters over ACA repeal-and-replace efforts by funding cost-sharing reduction subsidies and enforcing the mandate that requires most people to enroll in coverage. (Livingston, 5/10)