Washington – Aetna announced Thursday it is leaving Iowa’s Affordable Care Act marketplace and is considering abandoning the three remaining state exchanges it sells policies in this year.

Aetna spokesman T.J. Crawford said the insurer made the decision to leave Iowa’s exchange because of “financial risk and an uncertain outlook for the marketplace.”

“We are still evaluating Aetna’s 2018 individual product presence in our remaining states,” Crawford said.

Those remaining states are Nebraska, Virginia and Delaware. When the ACA exchanges became operational in October of 2013, Aetna participated in 17 state exchanges and was considering expansion into other state marketplaces, including Connecticut’s Access Health.

But the insurer – and many others – determined the customers in state exchanges, many of whom qualify for federal subsidies to help pay their premiums, were older and sicker than expected. An ACA reinsurance program to help offset the expense of high-cost customers, which gave insurers $7.9 billion for 2014 and $7.8 billion for 2015, was eliminated in 2016.

Wellmark Blue Cross/Blue Shield also announced on Thursday it will leave the Iowa exchange, citing double digit premium increases and a net loss of approximately $90 million in the exchange last year.

There’s been a steady drip-drip-drip of announcements from insurers about their concerns over staying in the exchanges.

Anthem told financial analysts it may quit the 14 states it participates in, including Connecticut.

Anthem said steps to stabilize the marketplaces, including eligibility verification, more rigid special enrollment periods, and shortening of premium grace periods are steps in the right direction, but not enough. The insurer has a deadline of July 1 to make up its mind whether to continue to sell policies on Access Health.

Another large insurer UnitedHealthcare, also is abandoning state exchanges and stopped selling policies on Access Health this year.

Republican House leaders who are trying to revive a bill that would repeal and replace the ACA, but failed to secure enough support for approval, said Thursday they would amend the bill to provide $15 billion to insurers to help them cover high-cost patients, much as the ACA’s reinsurance program did.

But the amendment to the stalled American Health Care Act, called the Federal Invisible Risk Sharing Program, does not say how that money would be distributed, leaving that to the Department of Health and Human Services.