As the future of the Affordable Care Act remains uncertain, insurers are struggling to prepare their health plans for the 2018 state and federal exchanges. The June 21 deadline for insurers to finalize plans under the federal health care exchange for 2018 is coming soon, but after Congress didn't pass a replacement to the ACA, insurers around the country are confused what this means for their health plans.

While the confusion is widespread, so is the commitment to providing insurance as long as the ACA exists. Oliver Wyman Health released a survey this week, which shows 96 percent of insurers say they are committed to staying in the exchanges. While the majority of insurers say they will stay, many also admit to rethinking their strategies in light of the confusion.

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And this is good news in light of data from the Department of Health and Human Services this week, which shows 25 of the 38 states with exchanges run through Healthcare.gov saw a decline in the number of insurers participating in their exchanges so far this year.

States with the most insurers leaving so far in 2017 were Arizona, Ohio, Pennsylvania and Texas, each with between five and nine insurers leaving the exchange.

Many insurers are hoping for more clarity after a meeting Tuesday with officials from the Trump administration, hoping they don't have to back out of exchanges.

But if these insurers don't get the information they need to plan accordingly, many health insurance providers are anticipating rate hikes which will only be burdensome for the consumer.

Part of the confusion for insurers came last week when President Donald Trump threatened to remove the ACA's subsidies — money for the poorest people on the exchanges to pay deductibles. Insurers are also concerned about whether there will be a federal mandate, because without it they will be paying for health care for the most expensive group, the old and sick.

A statement from the Department of Health and Human Services released last week said, "the administration is currently deciding its position" regarding the subsidies, so nothing is finalized.

This uncertainty over subsidies could lead to major increases in rates that would fall on the consumer, as the insurer would have to assume these costs.

The Oliver Wyman survey asked insurers to predict what these rate hikes could look like, and it could be dramatic. Of those insurers that responded they are considering an increase in price, a quarter say the price of insurance will jump 20 percent, while half say the increase will be between 10 and 20 percent. The highest expected increase reported was 35 percent.

With all of this in mind, consumers using Healthcare.gov or a state exchange to receive health insurance could be priced out. The Kaiser Family Foundation is looking into the issue, and estimates ACA plan costs could increase 19 percent if cost-sharing funding ends. The Congressional Budget Office also estimates increases if the mandate is removed, estimating the average cost for premiums could increase by 15 percent to 20 percent.

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