The challenge of purchasing individual health insurance is about to get even more challenging, with less competition and less choice, for consumers in nearly a dozen states. Humana, one of the four national-level insurers operating in the country, has announced that it’s quitting the marketplace exchanges set up by the Affordable Care Act next year.

Humana is pulling out of all 11 states where it still offers individual plans through the federal marketplace exchanges, the company announced last night.

The news came as part of a “strategy” memo, following the news that after their loss in court, Humana and Aetna were officially walking away from their plans to merge.

At the end of its “strategic update,” Humana noted that, “Based on its initial analysis of data associated with the company’s healthcare exchange membership following the 2017 open enrollment period, Humana is seeing further signs of an unbalanced risk pool. Therefore, the company has decided that it cannot continue to offer this coverage for 2018.”

Humana’s recently-failed merger partner Aetna also pulled out of the exchange marketplace in all but four states back in August.

At the time, Aetna claimed that it was simply losing too much money selling individual policies on the exchange.

However, when a federal judge rejected the Aetna/Humana merger in January, he also found that Aetna’s actions were motivated not so much by straight business concerns, but were deliberately intended as leverage to try to get their way with the merger.

As the LA Times reported, Aetna, “pulled out of some states and counties that were actually profitable to make a point in its lawsuit defense — and then misled the public about its motivations.”

By pulling out of the marketplace, the Times explains, Aetna could claim that its planned merger with Humana was not anticompetitive, because it had already stopped competing.

Of course, at this stage, we don’t have a clear idea what the exchange could look like in 2018 — or if there will even be an exchange.

The Republican majority in Congress, as well as President Trump, have all repeatedly vowed to repeal the ACA as quickly as possible. However, they have not offered any replacement solution for providing at least 18 million people with healthcare access the nonpartisan Congressional Budget Office estimates they will otherwise lose.

Work on dismantling the ACA has already started in the House, Senate, and Oval Office. No clear alternative plan has yet bubbled up with widespread support on Capitol Hill, though, nor has a clear strategy for repealing the existing law.

Health insurers, though, are businesses. They have a duty to shareholders to keep making money, and to avoid losing any where possible. And instability and uncertainty, of which we currently have plenty, can interfere with that.

Open enrollment for calendar year 2018 begins in November of this year, 2017. And that means insurers have to act in the first quarter of the year — so, now — to determine what their offerings, price points, and other details are going to look like.

There are now concerns that with competitors dropping out of the exchange, the marketplace could destabilize even further. Aetna CEO Mark Bertolini said at an event this morning that the ACA is in a “death spiral,” without mentioning that perhaps Aetna helped push that along when it withdrew last summer.

“I think you will see a lot more withdrawals this year of plans,” Bertolini added. “My anticipation would be that in ’18, we’ll see a lot of markets without any coverage at all.”

Trump himself clearly agreed, tweeting, “Obamacare continues to fail. Humana to pull out in 2018. Will repeal, replace & save healthcare for ALL Americans.”

However, the most recent announcement out of the White House today was not a further repeal agenda, but a regulation nominally aimed at “stabilizing” the marketplace.

The proposed rule not only allows plans in several coverage tiers to be less generous, but would also require anyone signing up outside of the standard open enrollment period to provide proof of their extenuating circumstances. It would also halve the open enrollment period for 2018, cutting it down down from the previously standard Nov. 1 – Jan. 31 to end on Dec. 15 instead.

Reducing the enrollment window will likely reduce the number of consumers who sign up for plans, thus reducing the risk that insurers will actually have to pay out to provide care for sick or injured persons.

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