Insurance giant Anthem continued its departure from Affordable Care Act (ACA) exchanges, announcing it will no longer offer plans in Nevada and 74 counties in Georgia.

"Today, planning and pricing for ACA-compliant health plans has become increasingly difficult due to a shrinking and deteriorating individual market, as well as continual changes and uncertainty in federal operations, rules and guidance, including cost-sharing reduction subsidies and the restoration of taxes on fully insured coverage," the company said in a statement.

The 85 counties where Anthem is remaining in Georgia would otherwise have no participating ACA carrier, while the 74 counties that will lose Anthem plans had competition for the insurer on the exchanges. Its previously announced exits is why 14 out of the 17 counties in Nevada are at risk of having no ACA insurer for next year.

According to the Nevada Department of Insurance, Anthem had taken initial steps to offer coverage in three of the state’s more populous counties in 2018, while asking for an average premium hike of 62 percent. Those rate requests didn’t reflect the possibility of the Trump administration cutting off cost-sharing reduction subsidies to insurers.

“The division is continuing to work with our state partners on attracting an insurance carrier to serve the 14 bare counties and to support the stability of the market for those insurance carriers who remain,” said Nevada Insurance Commissioner Barbara Richardson.

The announcement by Anthem follows departures by other major insurers like Aetna, UnitedHealth and Humana. The scaling back has left nearly 40 percent of counties nationwide—1,352 counties total—with only one insurer projected to participate in exchanges for 2018.

Other carriers have announced they’re staying put. In an interview with Axios, Intermountain Healthcare President and CEO Marc Harrison, MD, said its provider-sponsored health plan will continue to be available on the ACA exchange in its home state of Utah.

“These are our patients,” Harrison said. “We're not going anywhere. We're going to keep trying to figure this out. We're making the best possible financial and clinical decisions we can, and we are not going to cut and run because we actually believe in population health and we believe in value. The exchanges, although imperfect, are a mechanism to help us exercise our muscles and get better at this."