The state of Washington has had a very successful health insurance exchange, largely due to the fact that it has taken advantage of all the reforms offered by the Affordable Care Act, including expanding Medicaid and making its own state exchange.

However, the uncertainty over health care reform and how (and if) the American Health Care Act will be implemented has caused some trouble in the previously exemplary exchange.

According to Washington’s insurance commissioner, Mike Kreidler, 11 health insurers have filed 71 plans with the state for 2018. That still gives Washingtonians more options than are available in many states, but it’s less than half the number of plans offered in 2017.

“For months, we’ve worked closely with our health insurers and other stakeholders in a concerted effort to try to explain to the Trump administration and congressional leaders what the impact could be to our market and most importantly, to our consumers, if this level of uncertainty and volatility continued,” Kriedler said. “Today, our predictions came true.”

More troubling is that two counties—Klickitat and Grays Harbor—will have no insurers providing individual plans. As of March, those counties had more than 3,330 residents covered by individual plans.

But other states are faring far worse. Anthem said it would pull out of the Obamacare exchange in Ohio in 2018, leaving 18 counties potentially with no insurer. Likewise, 25 counties in Missouri could be without an Obamacare exchange policy because Blue Cross and Blue Shield of Kansas City is planning to leave the exchange.

Under Washington law, if no health insurer is available to sell insurance exchange plans in a county, customers of those plans can get coverage in the state’s high-risk pool (WSHIP). But because WSHIP is not a qualified exchange insurer, subsidies would not be available to enrollees.

Kriedler said that the exchange has “helped increase competition, provided better coverage and access, and fueled the largest drop in our uninsured in decades.”

“While we are seeing a number of carriers returning this year, we were also dismayed by the role federal uncertainty played into the decision of others to discontinue offering products or scale back their existing service areas,” said Pam MacEwan, CEO of the Washington Health Benefit Exchange.

Washington state’s insurance premiums will be announced on June 17, and some are expecting large increases. This has been the case in some other states. In New York, for example, insurers requested a premium increase of 16.6 percent. The hike is based on rising medical costs, an aging population, and a wider provider network. When New York asked insurers to estimate the impact of the Affordable Care Act’s repeal, carriers said it would cause insurance premiums to go up by 34 percent.

Although Washington state is laying the blame for the lack of insurance policies at the feet of the Trump administration, Alleigh Marre, a spokeswoman for the U.S. Department of Health and Human Services, disagrees.

“Obamacare has delivered higher prices and fewer choices for years. Last year alone, 83 insurers left the Obamacare marketplace, leaving millions of Americans paying more and getting less,” Marre said. “Now is the time to advance real health-care reform that empowers individuals and families with the choices and resources they need to buy a plan that meets their health-care needs without breaking their budgets.”

Regardless of which side of the Obamacare debate you are on, everyone agrees that major changes in health insurance and health care are coming.