Aetna officially no longer glad they met ya: They're out.

Hardly surprising given they made good on their "Give us our merger or we're out of here!" threat last year, followed by further drop-outs from both Iowa and Virginia announced for next year over the past few weeks, but the final Aetna shoe has just dropped:

.@Aetna will not offer on- or off-exchange individual plans in DE or NE for 2018, and at this time has completely exited the exchanges.

— T.J. Crawford (@TJatAetna) May 10, 2017

T.J. Crawford is apparently Aetna's head of media relations, so yeah, that seems pretty definitive.

A bit more courtesy of Peter Sullivan of The Hill:

Our individual Commercial products lost nearly $700 million between 2014 and 2016, and are projected to lose more than $200 million in 2017 despite a significant reduction in membership,” Aetna said in a statement. 

The company added that it has now “completely exited the exchanges.”

Aetna has taken a more negative outlook on the viability of the ObamaCare marketplaces than many other insurers. 

A report from S&P last month found that the financial situation was stabilizing for insurers on the marketplaces, absent drastic changes to the law from Washington. 

Still, many insurers are contemplating premium hikes or dropping out of the marketplaces next year, pointing in part to uncertainty from the Trump administration. 

Insurers are worried the administration will stop enforcing the mandate for people to get insurance, and that it will cancel key ObamaCare payments that President Trump has threatened to withhold as a bargaining chip with Democrats.

I'm not 100% sure whether Aetna is also dropping out of the off-exchange market in every state as well (the wording above specifies DE & NE only), but that seems likely. Also, there's some confusion over what this means for Nevada--just yesterday, Louise Norris reported that Aetna Better Health was planning on joining the Nevada ACA exchange next year, so I'm not sure what's up with that.

In any event, the pattern is the same: Some carriers improving, some still having real problems, but all of them seem to be pointing at Trump/GOP Uncertainty as one of the major reasons for either bailing completely or jacking up rates dramatically.

None of which helps the people in Iowa, Virginia, and now Delaware and Nebraska.

As far as I can tell, this leaves exactly one ACA exchange carrier left in both DE and NE:

• Delaware: Highmark BCBS

Highmark is currently participating in all 3 Delaware counties, not terribly surprising given how small the state is.

• Nebraska: Medica

Again, as far as I can tell, Medica currently serves every county in the state, so there should still be at least one exchange option statewide assuming they stick around.

Also worth noting: Aetna sent out a couple of infographics, one of which stated that as of the end of 2016 they had 964,000 individual market enrollees (on + off exchange combined) on which they lost $450 million, while as of March 31, 2017 they had 255,000 individual market enrollees (after dropping out of most states last year) on which they expect to lose $200 million for the full calendar year. Again, that's 255K both on & off exchange.