There has been an erosion in the number of insurance companies participating in the Affordable Care Act health insurance marketplaces. As insurers have exited states’ exchanges in recent years, the number of insurers has fallen to just one in these five states: Alabama, Alaska, Oklahoma, South Carolina, and Wyoming, according to data from the Menlo Park, California-based Kaiser Family Foundation.

Insurers are pulling out of ACA exchanges for various reasons.

In the August 2016 issue of Health Affairs, Nicholas Bagley of the University of Michigan Law School and Mike Adelberg, a former Medicare and Medicaid official, said one of the problems facing insurers is the the size of the risk pool. In the individual and small-group markets, particularly on the exchanges, individuals insured under the ACA are sicker than originally expected.

Click here to see the states where obamacare is disappearing.

The three ACA programs — reinsurance, risk corridors, and risk adjustment — that those who drafted Obamacare hoped would help keep premiums from rising unsustainably in the revamped markets have not performed as expected.

Uncertainty over whether the Trump administration will retain certain parts of the ACA has weighed on insurers. For example, Obamacare’s replacement may not help reduce medical costs that before the ACA placed a greater burden on low-income people.

Health insurance premiums on the ACA’s exchanges were expected to increase, largely because of the enrollment of previously excluded individuals with pre-existing conditions. Even faster increases were anticipated in 2017 because of insurers’ losses in this market and the phasing out of the ACA’s reinsurance program.

Of the 41 states where data is available, the average premium increased in all but Massachusetts and Indiana through 2016.

In 2014, there were an average of five insurers participating in each state’s ACA marketplace, according to Kaiser. There was an increase in insurer participation in 2015, with an average of six insurers per state. Insurer participation dipped in 2016 to 5.6 per state on average. The average number of insurers per state in 2017 is 4.3.

Insurer participation varies within states, and rural areas tend to have fewer insurers. On average, metropolitan-area counties have 2.5 insurers, compared with two in rural counties.

Of the 9.2 million consumers who have selected a marketplace plan, 2.5 million do so without any option, that is, there is only one insurer available.

To identify the states where Obamacare is disappearing, 24/7 Wall St. reviewed the number of marketplace insurers in every state for each year between 2014 — the first year the health care exchanges were fully operational — and 2017. The ranking is based on the share of insurers which have left the marketplace since the state’s peak number of insurers between 2014-2016. Data for this ranking came from the “Health Plan Choice and Premiums in the 2017 Health Insurance Marketplace” report by the Department of Health and Human Services.

The increase in premiums between 2016-2017 were based on the benchmark on which tax credits are calculated — the average monthly premiums for the second-lowest cost silver plans for a 27-year-old — in HealthCare.gov states and state-based marketplaces. Uninsured rates came from the U.S. Census Bureau’s 2015 American Consumer Survey.

50. Virginia
> 2017 insurers: 8 (8th highest)
> Peak marketplace insurers: 7 (tied-17th highest)
> 2016-2017 premium increase: 10.5% (20th lowest)
> Uninsured rate: 9.1% (tied-23rd highest)

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49. Delaware
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 2 (tied-the lowest)
> 2016-2017 premium increase: 18.8% (21st highest)
> Uninsured rate: 5.9% (8th lowest)

48. Hawaii
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 2 (tied-the lowest)
> 2016-2017 premium increase: 35.2% (13th highest)
> Uninsured rate: 4.0% (3rd lowest)

47. Idaho
> 2017 insurers: 5 (tied-12th highest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: N/A
> Uninsured rate: 11.0% (12th highest)

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46. Iowa
> 2017 insurers: 4 (tied-17th highest)
> Peak marketplace insurers: 4 (tied-15th lowest)
> 2016-2017 premium increase: 25.2% (19th highest)
> Uninsured rate: 5.0% (5th lowest)

45. Kansas
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 3 (tied-7th lowest)
> 2016-2017 premium increase: 41.9% (10th highest)
> Uninsured rate: 9.1% (tied-23rd highest)

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44. Maine
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 3 (tied-7th lowest)
> 2016-2017 premium increase: 15.3% (23rd lowest)
> Uninsured rate: 8.4% (24th lowest)

43. North Dakota
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 3 (tied-7th lowest)
> 2016-2017 premium increase: 6.7% (tied-16th lowest)
> Uninsured rate: 7.8% (21st lowest)

42. Vermont
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 2 (tied-the lowest)
> 2016-2017 premium increase: N/A
> Uninsured rate: 3.8% (2nd lowest)

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41. West Virginia
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 2 (tied-the lowest)
> 2016-2017 premium increase: 31.3% (14th highest)
> Uninsured rate: 6.0% (tied-9th lowest)

40. Wisconsin
> 2017 insurers: 15 (the highest)
> Peak marketplace insurers: 16 (tied-the highest)
> 2016-2017 premium increase: 16.0% (24th lowest)
> Uninsured rate: 5.7% (tied-6th lowest)

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39. California
> 2017 insurers: 11 (3rd highest)
> Peak marketplace insurers: 12 (6th highest)
> 2016-2017 premium increase: 6.7% (tied-16th lowest)
> Uninsured rate: 8.6% (25th lowest)

38. Massachusetts
> 2017 insurers: 9 (tied-6th highest)
> Peak marketplace insurers: 10 (tied-9th highest)
> 2016-2017 premium increase: -3.5% (9th lowest)
> Uninsured rate: 2.8% (the lowest)

37. New York
> 2017 insurers: 14 (2nd highest)
> Peak marketplace insurers: 16 (tied-the highest)
> 2016-2017 premium increase: N/A
> Uninsured rate: 7.1% (tied-19th lowest)

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36. Minnesota
> 2017 insurers: 4 (tied-17th highest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: 58.9% (4th highest)
> Uninsured rate: 4.5% (4th lowest)

35. New Hampshire
> 2017 insurers: 4 (tied-17th highest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: 1.9% (13th lowest)
> Uninsured rate: 6.3% (13th lowest)

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34. New Mexico
> 2017 insurers: 4 (tied-17th highest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: 28.7% (17th highest)
> Uninsured rate: 10.9% (tied-13th highest)

33. Arkansas
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 4 (tied-15th lowest)
> 2016-2017 premium increase: 1.6% (11th lowest)
> Uninsured rate: 9.5% (22nd highest)

32. Montana
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 4 (tied-15th lowest)
> 2016-2017 premium increase: 44.3% (8th highest)
> Uninsured rate: 11.6% (9th highest)

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31. Colorado
> 2017 insurers: 7 (9th highest)
> Peak marketplace insurers: 10 (tied-9th highest)
> 2016-2017 premium increase: N/A
> Uninsured rate: 8.1% (22nd lowest)

30. Michigan
> 2017 insurers: 9 (tied-6th highest)
> Peak marketplace insurers: 13 (5th highest)
> 2016-2017 premium increase: 7.0% (18th lowest)
> Uninsured rate: 6.1% (12th lowest)

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29. Mississippi
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 3 (tied-7th lowest)
> 2016-2017 premium increase: 18.7% (22nd highest)
> Uninsured rate: 12.7% (6th highest)

28. Missouri
> 2017 insurers: 4 (tied-17th highest)
> Peak marketplace insurers: 6 (tied-19th highest)
> 2016-2017 premium increase: 18.7% (23rd highest)
> Uninsured rate: 9.8% (20th highest)

27. North Carolina
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 3 (tied-7th lowest)
> 2016-2017 premium increase: 39.8% (11th highest)
> Uninsured rate: 11.2% (11th highest)

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26. Ohio
> 2017 insurers: 10 (tied-4th highest)
> Peak marketplace insurers: 15 (4th highest)
> 2016-2017 premium increase: 1.8% (12th lowest)
> Uninsured rate: 6.5% (15th lowest)

25. Rhode Island
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 3 (tied-7th lowest)
> 2016-2017 premium increase: N/A
> Uninsured rate: 5.7% (tied-6th lowest)

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24. South Dakota
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 3 (tied-7th lowest)
> 2016-2017 premium increase: 38.5% (12th highest)
> Uninsured rate: 10.2% (18th highest)

23. Washington
> 2017 insurers: 6 (tied-10th highest)
> Peak marketplace insurers: 9 (tied-12th highest)
> 2016-2017 premium increase: N/A
> Uninsured rate: 6.6% (tied-16th lowest)

22. Illinois
> 2017 insurers: 5 (tied-12th highest)
> Peak marketplace insurers: 8 (tied-14th highest)
> 2016-2017 premium increase: 43.3% (9th highest)
> Uninsured rate: 7.1% (tied-19th lowest)

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21. Pennsylvania
> 2017 insurers: 5 (tied-12th highest)
> Peak marketplace insurers: 8 (tied-14th highest)
> 2016-2017 premium increase: 53.5% (6th highest)
> Uninsured rate: 6.4% (14th lowest)

20. Texas
> 2017 insurers: 10 (tied-4th highest)
> Peak marketplace insurers: 16 (tied-the highest)
> 2016-2017 premium increase: 18.1% (24th highest)
> Uninsured rate: 17.1% (the highest)

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19. Louisiana
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: 17.2% (25th highest)
> Uninsured rate: 11.9% (8th highest)

18. Maryland
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: N/A
> Uninsured rate: 6.6% (tied-16th lowest)

17. Nevada
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: 6.4% (15th lowest)
> Uninsured rate: 12.3% (7th highest)

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16. Tennessee
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: 63.1% (3rd highest)
> Uninsured rate: 10.3% (17th highest)

15. Georgia
> 2017 insurers: 5 (tied-12th highest)
> Peak marketplace insurers: 9 (tied-12th highest)
> 2016-2017 premium increase: 15.2% (22nd lowest)
> Uninsured rate: 13.9% (tied-3rd highest)

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14. Oregon
> 2017 insurers: 6 (tied-10th highest)
> Peak marketplace insurers: 11 (tied-7th highest)
> 2016-2017 premium increase: 27.6% (18th highest)
> Uninsured rate: 7.0% (18th lowest)

13. Alaska
> 2017 insurers: 1 (tied-the lowest)
> Peak marketplace insurers: 2 (tied-the lowest)
> 2016-2017 premium increase: 28.8% (16th highest)
> Uninsured rate: 14.9% (2nd highest)

12. Connecticut
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 4 (tied-15th lowest)
> 2016-2017 premium increase: 16.8% (25th lowest)
> Uninsured rate: 6.0% (tied-9th lowest)

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11. Florida
> 2017 insurers: 5 (tied-12th highest)
> Peak marketplace insurers: 10 (tied-9th highest)
> 2016-2017 premium increase: 13.4% (21st lowest)
> Uninsured rate: 13.3% (5th highest)

10. Indiana
> 2017 insurers: 4 (tied-17th highest)
> Peak marketplace insurers: 8 (tied-14th highest)
> 2016-2017 premium increase: -2.6% (10th lowest)
> Uninsured rate: 9.6% (21st highest)

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9. Nebraska
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 4 (tied-15th lowest)
> 2016-2017 premium increase: 51.1% (7th highest)
> Uninsured rate: 8.2% (23rd lowest)

8. Utah
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 6 (tied-19th highest)
> 2016-2017 premium increase: 20.0% (20th highest)
> Uninsured rate: 10.5% (16th highest)

7. Wyoming
> 2017 insurers: 1 (tied-the lowest)
> Peak marketplace insurers: 2 (tied-the lowest)
> 2016-2017 premium increase: 8.7% (19th lowest)
> Uninsured rate: 11.5% (10th highest)

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6. Kentucky
> 2017 insurers: 3 (tied-23rd highest)
> Peak marketplace insurers: 7 (tied-17th highest)
> 2016-2017 premium increase: N/A
> Uninsured rate: 6.0% (tied-9th lowest)

5. New Jersey
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 5 (tied-21st highest)
> 2016-2017 premium increase: 5.1% (14th lowest)
> Uninsured rate: 8.7% (25th highest)

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4. Alabama
> 2017 insurers: 1 (tied-the lowest)
> Peak marketplace insurers: 3 (tied-7th lowest)
> 2016-2017 premium increase: 57.4% (5th highest)
> Uninsured rate: 10.1% (19th highest)

3. Oklahoma
> 2017 insurers: 1 (tied-the lowest)
> Peak marketplace insurers: 4 (tied-15th lowest)
> 2016-2017 premium increase: 68.9% (2nd highest)
> Uninsured rate: 13.9% (tied-3rd highest)

2. South Carolina
> 2017 insurers: 1 (tied-the lowest)
> Peak marketplace insurers: 4 (tied-15th lowest)
> 2016-2017 premium increase: 29.1% (15th highest)
> Uninsured rate: 10.9% (tied-13th highest)

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1. Arizona
> 2017 insurers: 2 (tied-6th lowest)
> Peak marketplace insurers: 11 (tied-7th highest)
> 2016-2017 premium increase: 115.3% (the highest)
> Uninsured rate: 10.8% (15th highest)

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