Blue Cross and Blue Shield of Illinois will be the only insurer offering PPO health insurance plans on the state’s Obamacare exchange next year, according to information released Friday by the state Department of Insurance.

That’s down from five insurers that offered individual PPO plans on the exchange this year. Many consumers prefer PPO health plans because, unlike HMO plans, they allow patients to see specialist doctors without a referral and see physicians who are out-of-network, albeit at higher costs.

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More than 250,000 people in North Carolina are losing the health plans they bought under the Affordable Care Act because two of the three insurers are dropping out — a stark example of the disruption roiling marketplaces in many parts of the country.

The defections mean that almost all of the state, from the Blue Ridge to the Outer Banks, will have just one insurer selling ACA policies when the exchanges open again for business in November. The remaining company, Blue Cross Blue Shield of North Carolina, agonized over whether to leave, too. Instead, it is raising its rates by nearly 25 percent.

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With so many insurers pulling out of ObamaCare’s health insurance Exchanges–”the craziest thing in the world,” according to Bill Clinton–hundreds of thousands or millions of enrollees will see their plans disappear. The federal government will send up to 20 notices to ObamaCare enrollees whose plans disappear—and will choose replacement plans if they don’t choose one themselves.

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A growing number of people in Obamacare are finding out their health insurance plans will disappear from the program next year, forcing them to find new coverage even as options shrink and prices rise.

At least 1.4 million people in 32 states will lose the Obamacare plan they have now, according to state officials contacted by Bloomberg. That’s largely caused by Aetna Inc., UnitedHealth Group Inc. and some state or regional insurers quitting the law’s marketsfor individual coverage.

Sign-ups for Obamacare coverage begin next month. Fallout from the quitting insurers has emerged as the latest threat to the law, which is also a major focal point in the U.S. presidential election.

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Obamacare will likely see a “significant slowdown” in enrollment next year, a Thursday analysis from S&P Global Ratings projects.

The report suggests effectuated marketplace enrollment will range between 10.2 million and 11.6 million in 2017. The analysts say their forecast “is clearly a bump in the road, but doesn’t signal ‘game over’ for the marketplace.”

“The marketplace would benefit from growth in enrollment, especially if it helps improve the morbidity of the risk pool. But 2017 will likely not be the year the marketplace sees significant expansion,” the report says.

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More than 50 conservative groups are asking lawmakers to block payments to insurers under Obamacare they say would be a “bailout” of insurance companies.

The groups, which include Freedom Partners, Americans for Prosperity, Americans for Tax Reform and Heritage Action, are calling on Congress in a Wednesday letter to block payments using taxpayer money from going to insurers under two Affordable Care Act programs.

The groups want Congress to recoup $5 billion they say was illegally given to insurance companies experiences greater losses than expected under the law’s reinsurance program and are urging lawmakers to pass a measure blocking future payments from a “Judgement Fund” to settle insurer lawsuits under the law’s risk corridor program.

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More than 50 fiscally conservative groups are asking Congress to prevent the Obama administration from giving insurers “bailouts” for their Obamacare losses.

Congress should take two steps toward that end, according to a letter sent Wednesday by Freedom Partners and dozens of other groups.

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The problems emerging in the exchanges are a symptom of a larger disease, which is that the ACA moved far too much power and regulatory control over the health sector to the federal government. Building a broader consensus around reform of the individual insurance market will almost certainly require revisiting other fundamental aspects of the ACA that have sharply divided policymakers.

The ACA exchanges will not be able to continue indefinitely without substantial reform. But reform will only be possible if the American public believes that this will not merely be another intrusion into their personal health decisions and their wallets. It will be up to Congress and the next President to decide if America’s health care system is worth the political risk needed to enact responsible and necessary reforms.

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The federal government will choose health plans for hundreds of thousands of consumers whose insurers have left the Affordable Care Act marketplace unless those people opt out of the law’s exchanges or select plans on their own, under a new policy to make sure consumers maintain coverage in 2017.

“Urgent: Your health coverage is at risk,” declares a sample “discontinuation notice,” drafted by the government for use by insurers. It tells consumers that “if you don’t enroll in a plan on your own, you may be automatically enrolled in the plan picked for you.”

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It keeps getting harder to sell Affordable Care Act policies, says Steven Mendelsohn, a Montgomery County licensed insurance salesman.

It’s bad enough that United Healthcare pulled out of the Pennsylvania exchange that sells the subsidized health insurance parties last year, when rates went up 10%. Or that Aetna — which less than 10 years ago dominated the local market for individual policies — stopped writing the policies here earlier this year, when rates went up another 10%.

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