DES MOINES, Iowa -- First it was Wellmak and now it's Aetna; Iowans with individual health insurance plans have now seen two out of the three providers in Iowa back out of the individual ACA marketplace.
"Essentially there really only is potential now for one option" said Insurance Commissioner Doug Ommen.
That lone company is Medica, which isn't a sure bet to continue their plans.
The company said through a spokesman "We are currently evaluating the situation and our options".
The move by Aetna affects over 35,000 Iowans. Two of those include Katie Spellman and her husband.
Spellman is self-employed as a photographer and her husband farms. She says the couple plans to start a family soon and cannot do without insurance if Medica leaves the marketplace as well.
"It's honestly something that keeps us up at night, but at the same time there's really no answer right now so we just try to work our way through it, try to keep up on the news with what we can and I assume we'll get another mailing at some point letting us know what our options are but I just don't know," said Spellman.
Insurance Commissioner Ommen says this is the result of companies losing money under the Affordable Care Act.
"The Affordable Care Act was designed to improve the circumstances in Iowa and I think time has proven that that's not the case," said Ommen.
Ommen says the solution is going to have to come from D.C.
"The federal government created this problem and now the federal government is going to have to find a solution," he said.
That may be easier said than done, the GOP failed to pass a healthcare bill last month amidst division within their own ranks.
President Trump had originally said he wanted to wait until the Affordable Care Act "exploded" before coming back to the table.
The administration is now trying to revive the bill in some form through compromise in order to appease both moderate and more conservative Republicans.