Health care exchanges already struggling to get off the ground in many states are facing new hurdles as major insurance companies express reservations over joining them.

Some of the nation's largest insurers have recently expressed their reluctance to join the exchanges, saying they are likely to sell insurance plans on less than a third of them.

The new state health exchanges set up under the Patient Protection and Affordable Care Act—just months away from opening—will, in part, determine the success of President Obama's landmark law. Without strong insurer participation, the exchanges will lack the competition the administration had promised.

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