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Two insurers announced this week that they would pull out of Iowa's Affordable Care Act exchanges next year, raising worries that the decisions could be the leading edge of a trend. Insurers face approaching deadlines and major uncertainties about the short-term viability of the exchanges, and beyond, because of politicians' inability thus far to move a specific repeal and replace plan forward. (Johnson, 4/6)

Aetna Inc will exit Iowa's Obamacare-compliant individual insurance market in 2018, a year surrounded by uncertainty over which insurers will sell plans and at what price as Republicans seek to dismantle the 2010 Affordable Care Act. (4/6)

Aetna said its move in Iowa came “as a result of financial risk and an uncertain outlook for the marketplace” and it was “still evaluating Aetna’s 2018 individual product presence in our remaining states.” Aetna currently offers exchange plans in four states -- Iowa, Delaware, Nebraska and Virginia -- a sharp reduction from its presence last year. It has more than 30,000 enrollees in Iowa. (Wilde Mathews,, 4/6)

Aetna’s brief statement didn’t detail its reasons. But the national carrier already had stopped selling such policies in 11 other states for 2017, citing turmoil in the wake of the Affordable Care Act. Wellmark cited similar reasons, plus the inability of Republicans controlling Congress to replace the Affordable Care Act with a plan that could provide more stability for the market. (Leys, 4/6)

The decision follows on the heels of Wellmark Blue Cross and Blue Shield's announcement that it will exit Iowa's individual market in 2018. Now thousands of Iowans will be forced to switch health insurers—if they can find one. (Livingston, 4/6)

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. (Radelat, 4/6)

In the absence of Aetna and Wellmark, Iowa has only two insurers providing individual policies. Minnesota-based Medica and Wisconsin based-Gundersen both have until this summer to decide if they'll continue participation in Iowa's individual insurance exchange. (Boden, 4/6)