The head of Tennessee’s insurance department said the state’s health insurance exchange is “very near collapse” after approving large rate increases for the three insurers offering coverage in 2017, according to The Tennessean.

Tennessee Department of Commerce Insurance Commissioner Julie McPeak approved a 62 percent average premium increase for Blue Cross Blue Shield (BCBS) of Tennessee, a 46 percent average rate increase for Cigna and a 44.3 percent average rate increase for Humana. BCBS, the only exchange insurer offering coverage statewide, covers nearly 69 percent of all exchange customers in the state, and another 15 percent will be looking for new plans with the exit of UnitedHealth.

“I would characterize the exchange market in Tennessee as very near collapse ... and that all of our efforts are really focused on making sure we have as many writers in the areas as possible, knowing that might be one," McPeak said. "I’m doing everything I can to prevent a situation where that turns to zero.”

McPeak defended the rate increases by saying Cigna and Humana could have chosen to leave the state’s exchanges if she hadn’t offered insurers the chance to submit new rate requests. Cigna nearly doubled its average increase from the original request of 23 request. Humana had originally asked for a 29 percent average hike.

There remains a threat that BCBS of Tennessee could leave the exchanges or reduce its footprint before open enrollment begin. Spokesman Ray Vaughan told The Tennessean the company has lost nearly $500 million in the three years since the exchanges opened.

“We agree with the assessment of the ACA marketplace in Tennessee. We appreciate the support of our request to close the gap between our rates and medical expenses for ACA marketplace plans. Beyond rates as we’ve discussed with the (TDCI), we continue to have concerns about uncertainty with the ACA at the federal level," Vaughn said. "Due to these concerns, we are keeping all of our options open at this point about participating in the 2017 marketplace. We anticipate making a final decision in mid-September.”

The increases aren’t limited to exchange plans. The Chattanooga Times Free Press reported Aetna, which isn’t participating in the state’s exchange, will increase premiums by 14 percent for its off-exchange individual market plans.

HHS told the Times Free Press that 85 percent of Tennessee residents qualify for federal subsidies to purchase exchange plans, shielding many from the increased costs. The agency said the average customer would be only be paying $2 per month more than they did in 2016.