Colorado’s nonprofit co-op insurer announced Friday that it will not offer plans in 2016, the third co-op to do so in a week. The decision means that Colorado will be the seventh of 23 taxpayer-funded co-ops to shut down. About $2 billion in government funding has been doled out to the co-ops that opened to offer more competition in the Obamacare marketplaces.

Beginning in FY 2014, policy changes introduced by the Affordable Care Act (ACA) have been driving Medicaid enrollment and spending growth. This report provides an overview of Medicaid enrollment and spending growth with a focus on state Fiscal Year (FY) 2015 and state Fiscal Year 2016. Findings are based on interviews and data provided by state Medicaid directors as part of the 15th annual survey of Medicaid directors in all 50 states and the District of Columbia conducted by the Kaiser Commission on Medicaid and the Uninsured (KCMU) and Health Management Associates (HMA). Information collected in the survey on policy actions taken during FY 2015 and FY 2016 can be found in the companion report. Key findings related to Medicaid enrollment and spending growth are described below.

A government watchdog overseeing the Department of Health and Human Services delivered the grim financial state of nearly all of the co-ops—that collectively received $2.4 billion—created under Obamacare several months ago.

Now, following the collapse of six of the 23 that launched in 2013, the co-ops, or consumer oriented and operated plans, face an uphill battle to solidify themselves as competitors in the health insurance market.

Kentucky’s health insurance co-operative joined the growing list of failed Obamacare co-operatives, announcing Wednesday it will cease operations by the end of the year.

Federal officials were so out of the loop about the failing state of the Kentucky Health co-operative last November they awarded it $20 million in additional “expansion funds” to allow it to sell health insurance to customers in nearby West Virginia.

Community Health Alliance, Tennessee’s health insurance co-op, will stop offering health insurance coverage in 2016, reports The Tennessean. The move will make nearly 27,000 individuals find insurance elsewhere. In January, the co-op froze enrollment. The organization will continue to pay out existing claims and slow down its operations, The Tennessean reports.

Colorado HealthOP is one of roughly 20 nationally that opened after Obamacare started. They were designed to shake up the traditional health insurance marketplaces, and provide an alternative. And they’ve done that. Co-op plans were often priced below their competitors and they gained a huge surge in customers. But with a lot of claims to pay that puts them on potentially shaky ground, said Scott Harrington.

Those who reflexively assert that conservative critics of Obamacare don’t have an alternative can’t make that charge. They never could. The architecture of a replacement plan was always taking shape, led by groups like the 2017 Project and people like my AEI colleague Jim Capretta. Governor Bush has laid it out in detail. And the more thoughtful candidates this cycle are aiming to run on it.