Anthem could join other health insurance giants UnitedHealth, Aetna and Humana in no longer offering plans on the Affordable Care Act’s marketplace in many states.

According to Bloomberg, the insurer’s net income decreased in its third quarter earnings report, with its medical spending increased to 85.5 cents of every dollar of premiums being spent on costs of care. Without better financial results from its exchange participation in the next year, the company may scale back.

“If we do not see clear evidence of an improving environment and a path towards sustainability in the marketplace, we will likely modify our strategy in 2018,” Anthem CEO Joseph Swedish said on an earnings conference call. “Clearly, 2017 is a critical year as we continue to assess the long-term viability of our exchange footprint.”

Specifically, Swedish said the federal government needs to help insurers lower premiums, as well as step up recruitment efforts, calling the 889,000 people signed up under its ACA exchange plans “short of our original expectations.”

For on how an Anthem exit could leave the marketplace with only regional and not-for-profit insurers, click on the link below: